Provider Demographics
NPI:1114294576
Name:ESSEX PHARMACY&SURGICALS
Entity Type:Organization
Organization Name:ESSEX PHARMACY&SURGICALS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:VINOD
Authorized Official - Middle Name:
Authorized Official - Last Name:BOPPANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-686-0373
Mailing Address - Street 1:1550 COUNTRY RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:MD
Mailing Address - Zip Code:21221-3906
Mailing Address - Country:US
Mailing Address - Phone:410-686-0373
Mailing Address - Fax:410-686-3675
Practice Address - Street 1:1550 COUNTRY RIDGE LN
Practice Address - Street 2:
Practice Address - City:ESSEX
Practice Address - State:MD
Practice Address - Zip Code:21221-3906
Practice Address - Country:US
Practice Address - Phone:410-686-0373
Practice Address - Fax:410-686-3675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-29
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD03433942OtherSTATE OF MARYLAND BUSINESS LICENSE