Provider Demographics
NPI:1568621456
Name:SHALOM PHARMACY
Entity Type:Organization
Organization Name:SHALOM PHARMACY
Other - Org Name:SHALOM PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABIODUN
Authorized Official - Middle Name:
Authorized Official - Last Name:AREWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-512-0868
Mailing Address - Street 1:9131 PISCATAWAY RD
Mailing Address - Street 2:STE 260
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-2508
Mailing Address - Country:US
Mailing Address - Phone:301-856-5663
Mailing Address - Fax:301-856-8563
Practice Address - Street 1:9131 PISCATAWAY RD
Practice Address - Street 2:STE 260
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-2508
Practice Address - Country:US
Practice Address - Phone:301-856-5663
Practice Address - Fax:301-856-8563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0004X
MDP047613336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2133990OtherNCPDP PROVIDER IDENTIFICATION NUMBER