Provider Demographics
NPI:1417422734
Name:OLD COURT LTC PHARMACY INC
Entity Type:Organization
Organization Name:OLD COURT LTC PHARMACY INC
Other - Org Name:OLD COURT LTC PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:EMEKA
Authorized Official - Middle Name:
Authorized Official - Last Name:NWODIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-521-9520
Mailing Address - Street 1:8607 LIBERTY RD
Mailing Address - Street 2:
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-4713
Mailing Address - Country:US
Mailing Address - Phone:410-521-9520
Mailing Address - Fax:410-521-9521
Practice Address - Street 1:8607 LIBERTY RD
Practice Address - Street 2:
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-4713
Practice Address - Country:US
Practice Address - Phone:410-521-9520
Practice Address - Fax:410-521-9521
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OLD COURT PHARMACY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-10-13
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDPW0520OtherDON'T HAVE FOR NOW