MEDICARE: FIBUS DRUG STORE INC

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	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	54920401	OTHER	MD	BLUE CROSS OF MARYLAND

General Provider Information

NPI Number	:	1396706891
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIBUS DRUG STORE INC

Provider Business Mailing Address
First Line	:	2101 GARRISON BLVD
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21216-2606
Country	:	US
Telephone Number	:	410-947-1800
Fax Number	:	410-566-9181

Provider Business Practice Location Address
First Line	:	2101 GARRISON BLVD
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21216-2606
Country	:	US
Telephone Number	:	410-947-1800
Fax Number	:	410-566-9181

Authorized Official
Title or Position	:	PHARMACIST
Name	:	MR. NORMAN LEE LEVIN
Credential	:	BS
Telephone Number	:	410-947-1800

Provider Enumeration Date	:	04/01/2006
Last Update Date	:	08/22/2020

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Directions to “FIBUS DRUG STORE INC ” Practice Location

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