Provider Demographics
NPI:1508200163
Name:PHARMVUE CORPORATION
Entity Type:Organization
Organization Name:PHARMVUE CORPORATION
Other - Org Name:SOUTHERN MARYLAND COMPOUNDING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:NAJWA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:301-645-2400
Mailing Address - Street 1:1282 SMALLWOOD DR W
Mailing Address - Street 2:SUITE 284
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-4732
Mailing Address - Country:US
Mailing Address - Phone:301-645-2400
Mailing Address - Fax:301-476-0382
Practice Address - Street 1:3460 OLD WASHINGTON RD
Practice Address - Street 2:SUITE 103
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-3240
Practice Address - Country:US
Practice Address - Phone:301-645-2400
Practice Address - Fax:301-476-0382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-24
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP05973333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD335728700Medicaid