MEDICARE: MIDDLE RIVER PHARMACY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy

General Provider Information

NPI Number	:	1275115503
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDDLE RIVER PHARMACY LLC

Provider Business Mailing Address
First Line	:	5003 RITCHIE HWY
Second Line	:
City	:	BROOKLYN
State	:	MD
Zip	:	21225-3048
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	28 KINGSTON RD
Second Line	:
City	:	MIDDLE RIVER
State	:	MD
Zip	:	21220-4814
Country	:	US
Telephone Number	:	410-781-1841
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. AJAY KHANNA
Credential	:
Telephone Number	:	410-781-1841

Provider Enumeration Date	:	04/26/2021
Last Update Date	:	04/26/2021

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Directions to “MIDDLE RIVER PHARMACY LLC ” Practice Location

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