Provider Demographics
NPI:1235482944
Name:LAXMI DURGA RX LLC
Entity Type:Organization
Organization Name:LAXMI DURGA RX LLC
Other - Org Name:EDMONDSON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:PRUDVI RAM REDDY
Authorized Official - Middle Name:
Authorized Official - Last Name:PEDAVEETI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-566-5565
Mailing Address - Street 1:4506 EDMONDSON AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-1506
Mailing Address - Country:US
Mailing Address - Phone:410-566-5565
Mailing Address - Fax:410-566-1969
Practice Address - Street 1:4506 EDMONDSON AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-1506
Practice Address - Country:US
Practice Address - Phone:410-566-5565
Practice Address - Fax:410-566-1969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-18
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP05769333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy