Provider Demographics
NPI:1013025717
Name:KLEINS FESTIVAL AT BEL AIR INC
Entity Type:Organization
Organization Name:KLEINS FESTIVAL AT BEL AIR INC
Other - Org Name:KLEIN'S SHOPRITE PHARMACY #549
Other - Org Type:Doing Business As
Authorized Official - Title/Position:THIRD PARTY ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:FIGUEROA RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-521-8439
Mailing Address - Street 1:5 BEL AIR SOUTH PKWY STE 301
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-6087
Mailing Address - Country:US
Mailing Address - Phone:443-512-8373
Mailing Address - Fax:443-512-8379
Practice Address - Street 1:5 BEL AIR SOUTH PKWY STE 301
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-6087
Practice Address - Country:US
Practice Address - Phone:443-512-8373
Practice Address - Fax:443-512-8379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP015413336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2116932OtherNCPDP PROVIDER IDENTIFICATION NUMBER
MD550692100Medicaid
MD550692100Medicaid