Provider Demographics
NPI:1619913233
Name:MANCHESTER DRUGS INC
Entity Type:Organization
Organization Name:MANCHESTER DRUGS INC
Other - Org Name:TANEYTOWN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLTON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:410-765-5240
Mailing Address - Street 1:417 E BALTIMORE ST
Mailing Address - Street 2:SUITE # A1
Mailing Address - City:TANEYTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21787-2300
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:417 E BALTIMORE ST
Practice Address - Street 2:SUITE #A1
Practice Address - City:TANEYTOWN
Practice Address - State:MD
Practice Address - Zip Code:21787-2300
Practice Address - Country:US
Practice Address - Phone:410-756-5240
Practice Address - Fax:410-756-5243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP03001333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2126363OtherOTHER ID NUMBER-COMMERCIAL NUMBER
MD368812700Medicaid
2126363OtherOTHER ID NUMBER-COMMERCIAL NUMBER