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General NPI Number Information
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NPI Number | 1932385515
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Entity Type | Organization
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Legal Business Name | WHITEMARSH PHARMACY
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Dates
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Enumeration Date | 01/14/2008
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Last Update Date | 01/14/2008
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Provider Practice Location Address
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Address Line | 4924 CAMPBELL BLVD SUITE 120
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City | NOTTINGHAM
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State | MD
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Zip | 21236-5908
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Country | US
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Telephone | 443-384-2500
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Fax | 443-384-2525
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Provider Business Mailing Address
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Address Line | 4924 CAMPBELL BLVD SUITE 120
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City | NOTTINGHAM
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State | MD
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Zip | 21236-5908
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Country | US
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Telephone | 443-384-2500
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Fax | 443-384-2525
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL N SOURANIS
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Credential | P.D.
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Telephone | 410-633-5050
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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 | PO4046
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | PO4046
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License Number State | MD
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