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General NPI Number Information
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NPI Number | 1699184705
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Entity Type | Organization
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Legal Business Name | PEMBROOKE HEALTH SERVICES LLC
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Dates
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Enumeration Date | 08/04/2014
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Last Update Date | 12/14/2020
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Provider Practice Location Address
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Address Line | 11355 PEMBROOKE SQ UNIT 100
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City | WALDORF
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State | MD
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Zip | 20603-4805
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Country | US
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Telephone | 443-528-1010
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Fax |
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Provider Business Mailing Address
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Address Line | 4515 CENTENNIAL LN
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City | ELLICOTT CITY
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State | MD
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Zip | 21042-6301
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Country | US
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Telephone | 443-528-1010
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Fax |
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Authorized Official
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Title or Position | MEMBER/OWNER
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Name | JON HABASHY
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Credential |
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Telephone | 301-932-7900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | MD
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