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General NPI Number Information
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NPI Number | 1790564417
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Entity Type | Organization
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Legal Business Name | AVALON PROFESSIONAL PHARMACY LLC
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Dates
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Enumeration Date | 09/22/2023
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Last Update Date | 12/08/2025
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Provider Practice Location Address
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Address Line | 12100 ANNAPOLIS RD UNIT 2
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City | GLENN DALE
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State | MD
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Zip | 20769
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Country | US
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Telephone | 301-383-0142
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Fax | 301-383-0143
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Provider Business Mailing Address
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Address Line | 12100 ANNAPOLIS RD UNIT 2
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City | GLENN DALE
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State | MD
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Zip | 20769
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Country | US
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Telephone | 301-383-0142
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Fax | 301-383-0143
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Authorized Official
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Title or Position | PHARMACY OWNER/PHARMACY MANAGER
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Name | MR. JASON C MADUKA
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Credential | RPH
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Telephone | 301-383-0142
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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 |
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License Number State |
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