Provider Demographics
NPI:1275023061
Name:CORNER MARKET & PHARMACY WOODLEY GARDENS LLC
Entity Type:Organization
Organization Name:CORNER MARKET & PHARMACY WOODLEY GARDENS LLC
Other - Org Name:CORNER MARKET & PHARMACY WOODLEY GARDENS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELNAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:DARJ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-690-8340
Mailing Address - Street 1:1119 NELSON ST
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-2030
Mailing Address - Country:US
Mailing Address - Phone:301-690-8340
Mailing Address - Fax:301-690-8341
Practice Address - Street 1:1119 NELSON ST
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-2030
Practice Address - Country:US
Practice Address - Phone:301-690-8340
Practice Address - Fax:301-690-8341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-16
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP07882333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2177844OtherPK