=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750985206
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SS RX LLC DBA POCOMOKE CITY PHARMACY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/25/2020
-----------------------------------------------------
Last Update Date | 11/25/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1300 MARKET ST
-----------------------------------------------------
City | POCOMOKE CITY
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21851-1708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-957-7941
-----------------------------------------------------
Fax | 410-957-7946
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1300 MARKET ST
-----------------------------------------------------
City | POCOMOKE CITY
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21851-1708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-957-7941
-----------------------------------------------------
Fax | 410-957-7946
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | MR. HARINATH GANGASANI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 410-957-7941
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------