Provider Demographics
NPI:1114275708
Name:DEALE PHARMACY LLC
Entity Type:Organization
Organization Name:DEALE PHARMACY LLC
Other - Org Name:DEALE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SURINDER
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-867-2455
Mailing Address - Street 1:5809 DEALE CHURCHTON RD
Mailing Address - Street 2:
Mailing Address - City:DEALE
Mailing Address - State:MD
Mailing Address - Zip Code:20751-2203
Mailing Address - Country:US
Mailing Address - Phone:410-867-2455
Mailing Address - Fax:410-867-2466
Practice Address - Street 1:5809 DEALE CHURCHTON RD
Practice Address - Street 2:
Practice Address - City:DEALE
Practice Address - State:MD
Practice Address - Zip Code:20751-2203
Practice Address - Country:US
Practice Address - Phone:410-867-2455
Practice Address - Fax:410-867-2466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-29
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
MDP057453336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2137034OtherPK