Provider Demographics
NPI:1538501945
Name:ZEAN PHARMACY LLC
Entity Type:Organization
Organization Name:ZEAN PHARMACY LLC
Other - Org Name:ZEAN PHARMACY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:BYUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:JANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-750-8700
Mailing Address - Street 1:114 CLAIREDGE CT
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-2921
Mailing Address - Country:US
Mailing Address - Phone:410-336-4211
Mailing Address - Fax:
Practice Address - Street 1:8801 BALTIMORE NATIONAL PIKE
Practice Address - Street 2:STE 11D
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-4123
Practice Address - Country:US
Practice Address - Phone:410-750-8700
Practice Address - Fax:410-750-8718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-26
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP060393336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2141306OtherPK
MD442835800Medicaid