MEDICARE: AME PHARMACY IMMUNIZATION

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699325787
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AME PHARMACY IMMUNIZATION

Provider Business Mailing Address
First Line	:	2813 GREEN LAKE CIR
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21209-3859
Country	:	US
Telephone Number	:	443-324-3144
Fax Number	:

Provider Business Practice Location Address
First Line	:	731 FREDERICK RD
Second Line	:
City	:	CATONSVILLE
State	:	MD
Zip	:	21228-4503
Country	:	US
Telephone Number	:	410-719-2020
Fax Number	:	410-719-6915

Authorized Official
Title or Position	:	PHARMACIST
Name	:	IRINA HERBST
Credential	:	PHARM D
Telephone Number	:	410-719-2020

Provider Enumeration Date	:	09/19/2019
Last Update Date	:	09/19/2019

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Directions to “AME PHARMACY IMMUNIZATION ” Practice Location

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