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General NPI Number Information
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NPI Number | 1649470220
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Entity Type | Organization
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Legal Business Name | PARTNERS PHARMACY OF MARYLAND LLC
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Dates
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Enumeration Date | 07/20/2007
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Last Update Date | 11/12/2020
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Provider Practice Location Address
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Address Line | 8910 ROUTE 108 SUITE C
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City | COLUMBIA
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State | MD
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Zip | 21045-2151
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Country | US
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Telephone | 410-910-9260
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Fax | 410-740-0146
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Provider Business Mailing Address
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Address Line | 8910 ROUTE 108 SUITE C
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City | COLUMBIA
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State | MD
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Zip | 21045-2151
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Country | US
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Telephone | 410-910-9260
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Fax | 410-740-0146
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Authorized Official
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Title or Position | VICE-PRESIDENT OF COMPLIANCE
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Name | JODY FENELON
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Credential |
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Telephone | 815-985-4873
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | PW0304
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License Number State | MD
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