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General NPI Number Information
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NPI Number | 1891049318
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Entity Type | Organization
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Legal Business Name | MANCHESTER PHARMACY, INC
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Dates
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Enumeration Date | 11/06/2012
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Last Update Date | 11/06/2012
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Provider Practice Location Address
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Address Line | 3321 MAIN ST UNIT A1
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City | MANCHESTER
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State | MD
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Zip | 21102-1790
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Country | US
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Telephone | 410-239-2300
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 886
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City | MANCHESTER
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State | MD
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Zip | 21102-0886
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Country | US
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Telephone | 410-239-2300
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN ROBERT GLEESPEN
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Credential | PHARMD
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Telephone | 410-239-2300
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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 | PO4029
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License Number State | MD
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