Provider Demographics
NPI:1619060050
Name:D & D PHARMACY INC TA PURDUM PHARMACY
Entity Type:Organization
Organization Name:D & D PHARMACY INC TA PURDUM PHARMACY
Other - Org Name:PURDUM PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:NORTON
Authorized Official - Middle Name:JOEL
Authorized Official - Last Name:GROSSBLATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-377-5600
Mailing Address - Street 1:3410 GARRISON FARNS RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6901 YORK RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-1510
Practice Address - Country:US
Practice Address - Phone:410-377-5600
Practice Address - Fax:410-377-5050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-30
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06165183500000X
MDP00592333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes333600000XSuppliersPharmacyGroup - Single Specialty
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2101979OtherOTHER ID NUMBER-COMMERCIAL NUMBER
MD028442400Medicaid
MD1619060050Medicaid