Provider Demographics
NPI:1083629604
Name:N AND N CATONSVILLE
Entity Type:Organization
Organization Name:N AND N CATONSVILLE
Other - Org Name:CROSSROADS DISCOUNT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NAVEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAMBUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-722-5881
Mailing Address - Street 1:7001 JOHNNYCAKE RD
Mailing Address - Street 2:STE 100
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21244-2418
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7001 JOHNNYCAKE RD
Practice Address - Street 2:STE 100
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21244-2418
Practice Address - Country:US
Practice Address - Phone:410-788-6355
Practice Address - Fax:410-788-7443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP04364333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered333600000XSuppliersPharmacy
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2132708OtherOTHER ID NUMBER-COMMERCIAL NUMBER