MEDICARE: PROUDFOOTS OAKLAND PHARMACY

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	P00589	MD

General Provider Information

NPI Number	:	1710924212
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROUDFOOTS OAKLAND PHARMACY

Provider Business Mailing Address
First Line	:	PO BOX 387
Second Line	:	106 S. SECOND STREET
City	:	OAKLAND
State	:	MD
Zip	:	21550-0387
Country	:	US
Telephone Number	:	301-334-3913
Fax Number	:

Provider Business Practice Location Address
First Line	:	106 S 2ND ST
Second Line	:
City	:	OAKLAND
State	:	MD
Zip	:	21550-1520
Country	:	US
Telephone Number	:	301-334-3913
Fax Number	:

Authorized Official
Title or Position	:	PHARMACIST
Name	:	MISS MILTON HALL PROUDFOOT
Credential	:
Telephone Number	:	301-334-3913

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	08/22/2020

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