Provider Demographics
NPI:1003024670
Name:UTA PHARMACY
Entity Type:Organization
Organization Name:UTA PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MERCY
Authorized Official - Middle Name:
Authorized Official - Last Name:NNANNA
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:410-668-6877
Mailing Address - Street 1:7116 DARLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-7013
Mailing Address - Country:US
Mailing Address - Phone:410-668-6877
Mailing Address - Fax:
Practice Address - Street 1:7116 DARLINGTON DR
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21234-7013
Practice Address - Country:US
Practice Address - Phone:410-668-6877
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2007-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDPO45773336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy