Provider Demographics
NPI:1134500994
Name:ALPHA HEALTHCARE LLC
Entity Type:Organization
Organization Name:ALPHA HEALTHCARE LLC
Other - Org Name:ALPHA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CLEMENT
Authorized Official - Middle Name:ADEBOYE
Authorized Official - Last Name:ADEBAYO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-453-9383
Mailing Address - Street 1:3061 FREDERICK AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21223-2715
Mailing Address - Country:US
Mailing Address - Phone:443-453-9383
Mailing Address - Fax:443-453-9483
Practice Address - Street 1:3061 FREDERICK AVE
Practice Address - Street 2:SUITE C
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21223-2715
Practice Address - Country:US
Practice Address - Phone:443-453-9383
Practice Address - Fax:443-453-9483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-17
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP068763336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy