Provider Demographics
NPI:1639404775
Name:MED ONE PHARMACY INC
Entity Type:Organization
Organization Name:MED ONE PHARMACY INC
Other - Org Name:MIDDLETOWN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
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:301-620-4302
Mailing Address - Street 1:4317 OLD NATIONAL PIKE
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21769-7700
Mailing Address - Country:US
Mailing Address - Phone:301-371-8145
Mailing Address - Fax:301-371-8147
Practice Address - Street 1:4317 OLD NATIONAL PIKE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:MD
Practice Address - Zip Code:21769-7700
Practice Address - Country:US
Practice Address - Phone:301-371-8145
Practice Address - Fax:301-371-8147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-07
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP050733336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2134891OtherNCPDP PROVIDER IDENTIFICATION NUMBER