Provider Demographics
NPI:1629116298
Name:MED ONE PHARMACY INC
Entity Type:Organization
Organization Name:MED ONE PHARMACY INC
Other - Org Name:MT. AIRY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-712-7865
Mailing Address - Street 1:1 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:MD
Mailing Address - Zip Code:21771-5677
Mailing Address - Country:US
Mailing Address - Phone:301-831-7111
Mailing Address - Fax:410-549-7627
Practice Address - Street 1:1 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:MD
Practice Address - Zip Code:21771-5677
Practice Address - Country:US
Practice Address - Phone:301-831-7111
Practice Address - Fax:410-549-7627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-03
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MDP072383336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2166517OtherPK