Provider Demographics
NPI:1073676524
Name:GALENA PHARMACY, INC.
Entity Type:Organization
Organization Name:GALENA PHARMACY, INC.
Other - Org Name:GALENA PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHCST
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-648-5662
Mailing Address - Street 1:PO BOX 212
Mailing Address - Street 2:
Mailing Address - City:GALENA
Mailing Address - State:MD
Mailing Address - Zip Code:21635-0212
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:104 W CROSS ST
Practice Address - Street 2:
Practice Address - City:GALENA
Practice Address - State:MD
Practice Address - Zip Code:21635-1558
Practice Address - Country:US
Practice Address - Phone:410-648-5662
Practice Address - Fax:410-648-6938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MDP010353336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD460172600Medicaid
2033776OtherPK