Provider Demographics
NPI:1447608963
Name:THE MEDICINE SHOPPE PHARMACY
Entity Type:Organization
Organization Name:THE MEDICINE SHOPPE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ASMA
Authorized Official - Middle Name:
Authorized Official - Last Name:NIAZI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:410-789-8722
Mailing Address - Street 1:5507 RITCHIE HWY STE A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21225-3472
Mailing Address - Country:US
Mailing Address - Phone:410-789-8722
Mailing Address - Fax:
Practice Address - Street 1:5507 RITCHIE HWY STE A
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MD
Practice Address - Zip Code:21225-3472
Practice Address - Country:US
Practice Address - Phone:410-789-8722
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-25
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP046693336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD015476800Medicaid