Provider Demographics
NPI:1558760363
Name:BIOMATRIX SPECIALTY PHARMACY OF MARYLAND, LLC
Entity Type:Organization
Organization Name:BIOMATRIX SPECIALTY PHARMACY OF MARYLAND, LLC
Other - Org Name:ONCOSOURCERX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO & PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:KARALIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-545-6040
Mailing Address - Street 1:6992 COLUMBIA GATEWAY DR STE 220
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-2986
Mailing Address - Country:US
Mailing Address - Phone:888-662-6779
Mailing Address - Fax:877-800-4790
Practice Address - Street 1:6992 COLUMBIA GATEWAY DR STE 220
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-2986
Practice Address - Country:US
Practice Address - Phone:443-518-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BIOMATRIX SPECIALTY PHARMACY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-08-18
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2147365OtherPK