Provider Demographics
NPI:1194003087
Name:MED ONE PHARMACY INC
Entity Type:Organization
Organization Name:MED ONE PHARMACY INC
Other - Org Name:WOODBINE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-712-7865
Mailing Address - Street 1:710 LISBON CENTER DR STE D
Mailing Address - Street 2:
Mailing Address - City:WOODBINE
Mailing Address - State:MD
Mailing Address - Zip Code:21797-8629
Mailing Address - Country:US
Mailing Address - Phone:410-489-2708
Mailing Address - Fax:410-489-2762
Practice Address - Street 1:710 LISBON CENTER DR STE D
Practice Address - Street 2:
Practice Address - City:WOODBINE
Practice Address - State:MD
Practice Address - Zip Code:21797-8629
Practice Address - Country:US
Practice Address - Phone:410-489-2708
Practice Address - Fax:410-489-2762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-27
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
MDP055423336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2131201OtherPK
MD332513000Medicaid