Provider Demographics
NPI:1417249756
Name:NEW MARKET PHARMACT, LLC
Entity Type:Organization
Organization Name:NEW MARKET PHARMACT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST (MEMBER)
Authorized Official - Prefix:DR
Authorized Official - First Name:AWET
Authorized Official - Middle Name:
Authorized Official - Last Name:GEBREGZIABHER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:301-472-1987
Mailing Address - Street 1:29015 THREE NOTCH RD UNIT # 7
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20659
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11709 FAIR OAKS WAY
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-3192
Practice Address - Country:US
Practice Address - Phone:301-472-1987
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-04
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy