Provider Demographics
NPI:1346313400
Name:HOLABIRD PHARMACY, INC DBA UNIVERSAL HEALTH
Entity Type:Organization
Organization Name:HOLABIRD PHARMACY, INC DBA UNIVERSAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LICHTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CO, BOCO
Authorized Official - Phone:410-282-3300
Mailing Address - Street 1:7151 HOLABIRD AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21222-1726
Mailing Address - Country:US
Mailing Address - Phone:410-282-3300
Mailing Address - Fax:410-282-3333
Practice Address - Street 1:23 CROSSROADS DR
Practice Address - Street 2:SUITE 325
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5420
Practice Address - Country:US
Practice Address - Phone:410-282-3300
Practice Address - Fax:410-282-3333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC14358335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0297180001Medicare ID - Type Unspecified