Provider Demographics
NPI:1528599677
Name:LOWER SHORE PHARMACY
Entity Type:Organization
Organization Name:LOWER SHORE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:F
Authorized Official - Last Name:FELDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-292-3730
Mailing Address - Street 1:200 CHATTOLANEE HILL RD
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-4315
Mailing Address - Country:US
Mailing Address - Phone:410-292-3730
Mailing Address - Fax:
Practice Address - Street 1:505 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-5020
Practice Address - Country:US
Practice Address - Phone:410-341-4710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SEQUON, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-21
Last Update Date:2017-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD120397500Medicaid