Provider Demographics
NPI:1376861070
Name:BREATHE4SURE PHARMACY SOLUTIONS
Entity Type:Organization
Organization Name:BREATHE4SURE PHARMACY SOLUTIONS
Other - Org Name:PHARMACYSOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO, RPH
Authorized Official - Prefix:
Authorized Official - First Name:MAISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-324-2719
Mailing Address - Street 1:643 N CAREY ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21217-2410
Mailing Address - Country:US
Mailing Address - Phone:410-728-6337
Mailing Address - Fax:
Practice Address - Street 1:643 N CAREY ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21217-2410
Practice Address - Country:US
Practice Address - Phone:410-728-6337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-06
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MDP048323336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2135261OtherNCPDP PROVIDER IDENTIFICATION NUMBER