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General NPI Number Information
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NPI Number | 1689122483
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Entity Type | Organization
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Legal Business Name | MEDOVILLE PHARMACY INC.
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Dates
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Enumeration Date | 09/21/2016
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Last Update Date | 09/21/2016
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Provider Practice Location Address
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Address Line | 12821 OAK HILL AVE
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City | HAGERSTOWN
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State | MD
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Zip | 21742-2940
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Country | US
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Telephone | 301-378-2334
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Fax | 240-715-9199
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Provider Business Mailing Address
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Address Line | 110 BAUGHMANS LN STE 106
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City | FREDERICK
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State | MD
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Zip | 21702-4059
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Country | US
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Telephone | 301-378-2334
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Fax | 240-715-9199
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Authorized Official
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Title or Position | PRESIDENT
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Name | SIHAM BENSALAH
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Credential |
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Telephone | 301-378-2334
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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