Provider Demographics
NPI:1518527704
Name:KOULWARD HEALTH LLC POPULATION HEALTH PHARMACY
Entity Type:Organization
Organization Name:KOULWARD HEALTH LLC POPULATION HEALTH PHARMACY
Other - Org Name:ST. JOSEPH MEDICAL CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:SYAM
Authorized Official - Middle Name:
Authorized Official - Last Name:POTLURI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-823-3350
Mailing Address - Street 1:7505 OSLER DR
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-7736
Mailing Address - Country:US
Mailing Address - Phone:443-279-1998
Mailing Address - Fax:443-895-4554
Practice Address - Street 1:7505 OSLER DR
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7736
Practice Address - Country:US
Practice Address - Phone:443-279-1998
Practice Address - Fax:443-895-4554
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KOULWARD HEALTH LLC POPULATION HEALTH PHARMACY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-06-19
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy