Provider Demographics
NPI:1659095263
Name:BALTIMORE MEDICAL SYSTEM, INC.
Entity Type:Organization
Organization Name:BALTIMORE MEDICAL SYSTEM, INC.
Other - Org Name:BALTIMORE MEDICAL SYSTEM, INC. ROSEDALE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF PHARMACY OPERATIONS
Authorized Official - Prefix:DR
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:443-703-3654
Mailing Address - Street 1:5525 EASTERN AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-2796
Mailing Address - Country:US
Mailing Address - Phone:443-703-3654
Mailing Address - Fax:443-703-3238
Practice Address - Street 1:9520 PHILADELPHIA RD
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:MD
Practice Address - Zip Code:21237-4106
Practice Address - Country:US
Practice Address - Phone:443-596-6200
Practice Address - Fax:443-596-6201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-27
Last Update Date:2023-12-08
Deactivation Date:2023-05-13
Deactivation Code:
Reactivation Date:2023-06-01
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy