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General NPI Number Information
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NPI Number | 1679570253
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Entity Type | Organization
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Legal Business Name | NORTHGATE PHARMACY INC.
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Dates
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Enumeration Date | 06/28/2005
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 3973 SAINT CHARLES PKWY
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City | WALDORF
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State | MD
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Zip | 20602-2683
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Country | US
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Telephone | 301-932-7977
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Fax | 301-932-9373
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Provider Business Mailing Address
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Address Line | 3973 SAINT CHARLES PKWY
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City | WALDORF
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State | MD
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Zip | 20602-2683
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Country | US
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Telephone | 301-932-7977
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Fax | 301-932-9373
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Authorized Official
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Title or Position | PHARMACIST/PRESIDENT
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Name | MR. VINCENT IPPOLITO
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Credential | RPH
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Telephone | 301-932-7977
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | P04037
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License Number State | MD
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