Provider Demographics
NPI:1326021122
Name:MED ONE PHARMACY INC
Entity Type:Organization
Organization Name:MED ONE PHARMACY INC
Other - Org Name:BOONSBORO PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
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 1:7628 OLD NATIONAL PIKE
Mailing Address - Street 2:
Mailing Address - City:BOONSBORO
Mailing Address - State:MD
Mailing Address - Zip Code:21713-2002
Mailing Address - Country:US
Mailing Address - Phone:301-432-5488
Mailing Address - Fax:301-432-2466
Practice Address - Street 1:7628 OLD NATIONAL PIKE
Practice Address - Street 2:
Practice Address - City:BOONSBORO
Practice Address - State:MD
Practice Address - Zip Code:21713-2002
Practice Address - Country:US
Practice Address - Phone:301-432-5488
Practice Address - Fax:301-432-2466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-25
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MDP058793336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2138760OtherPK
2108822OtherNCPDP PROVIDER IDENTIFICATION NUMBER