Provider Demographics
NPI:1598040073
Name:SINAI HOSPITAL OF BALTIMORE INC
Entity Type:Organization
Organization Name:SINAI HOSPITAL OF BALTIMORE INC
Other - Org Name:THE LIFEBRIDGE PHARMACY AT SINAI HOSPITAL
Other - Org Type:Other Name
Authorized Official - Title/Position:COO, OUTPATIENT PHARMACY SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:410-701-4531
Mailing Address - Street 1:2401 W BELVEDERE AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-5216
Mailing Address - Country:US
Mailing Address - Phone:410-601-7100
Mailing Address - Fax:410-601-7131
Practice Address - Street 1:2401 W BELVEDERE AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-5216
Practice Address - Country:US
Practice Address - Phone:410-601-7100
Practice Address - Fax:410-601-7131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-17
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP055853336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2131805OtherPK
MD550605100Medicaid