Provider Demographics
NPI:1033306519
Name:WYE OAK INC
Entity Type:Organization
Organization Name:WYE OAK INC
Other - Org Name:WYE OAK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANG
Authorized Official - Prefix:
Authorized Official - First Name:GLADYS
Authorized Official - Middle Name:
Authorized Official - Last Name:MAKOGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-356-0555
Mailing Address - Street 1:1935 LANSDOWNE RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21227-1707
Mailing Address - Country:US
Mailing Address - Phone:410-536-0555
Mailing Address - Fax:410-536-0231
Practice Address - Street 1:1935 LANSDOWNE RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21227-1707
Practice Address - Country:US
Practice Address - Phone:410-536-0555
Practice Address - Fax:410-536-0231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-28
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0004X
MDP046503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2038284OtherPK