Provider Demographics
NPI:1477593127
Name:MONUMENT PHARMACY, INC.
Entity Type:Organization
Organization Name:MONUMENT PHARMACY, INC.
Other - Org Name:MONUMENT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHONFELD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:410-276-7586
Mailing Address - Street 1:2760 LIGHTHOUSE PT E
Mailing Address - Street 2:STE 110
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-5054
Mailing Address - Country:US
Mailing Address - Phone:410-276-7586
Mailing Address - Fax:410-276-7587
Practice Address - Street 1:2760 LIGHTHOUSE PT E STE 110
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-5054
Practice Address - Country:US
Practice Address - Phone:410-276-7586
Practice Address - Fax:410-276-7587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336I0012X
MDPW01903336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2032793OtherPK
MD405469500Medicaid