Provider Demographics
NPI:1073117750
Name:MID-ATLANTIC VENTURES, INC
Entity Type:Organization
Organization Name:MID-ATLANTIC VENTURES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST MANAGER & OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:ISAAC
Authorized Official - Last Name:OLAJIDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-566-1360
Mailing Address - Street 1:2021 W PRATT ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21223-2242
Mailing Address - Country:US
Mailing Address - Phone:410-566-1360
Mailing Address - Fax:
Practice Address - Street 1:2021 W PRATT ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21223-2242
Practice Address - Country:US
Practice Address - Phone:410-566-1360
Practice Address - Fax:410-566-5088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy