Provider Demographics
NPI:1083705305
Name:PTR INC.
Entity Type:Organization
Organization Name:PTR INC.
Other - Org Name:PASADENA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:PETR
Authorized Official - Suffix:
Authorized Official - Credentials:PD
Authorized Official - Phone:410-255-6000
Mailing Address - Street 1:743 S CONKLING ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-4302
Mailing Address - Country:US
Mailing Address - Phone:410-327-7252
Mailing Address - Fax:410-563-1081
Practice Address - Street 1:2932 MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-2014
Practice Address - Country:US
Practice Address - Phone:410-255-6000
Practice Address - Fax:410-360-2107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP013053336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0623310001Medicare ID - Type Unspecified