Provider Demographics
NPI:1558360040
Name:BANK PHARMACEUTICALS
Entity Type:Organization
Organization Name:BANK PHARMACEUTICALS
Other - Org Name:D/B/A BRAD'S OLDTOWN ROAD PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CHIEF PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:PD RPH
Authorized Official - Phone:301-729-6226
Mailing Address - Street 1:1101 E OLDTOWN ROAD
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502
Mailing Address - Country:US
Mailing Address - Phone:301-729-6226
Mailing Address - Fax:301-729-4229
Practice Address - Street 1:1101 E OLDTOWN ROAD
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502
Practice Address - Country:US
Practice Address - Phone:301-729-6226
Practice Address - Fax:301-729-4229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-18
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDPO3132333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD402214900Medicaid
MD402995000Medicaid
MD402214900Medicaid