Provider Demographics
NPI:1679570253
Name:NORTHGATE PHARMACY INC.
Entity Type:Organization
Organization Name:NORTHGATE PHARMACY INC.
Other - Org Name:NORTHGATE CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:IPPOLITO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:301-932-7977
Mailing Address - Street 1:3973 SAINT CHARLES PKWY
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-2683
Mailing Address - Country:US
Mailing Address - Phone:301-932-7977
Mailing Address - Fax:301-932-9373
Practice Address - Street 1:3973 SAINT CHARLES PKWY
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-2683
Practice Address - Country:US
Practice Address - Phone:301-932-7977
Practice Address - Fax:301-932-9373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP04037333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD456785OtherCDS NUMBER
MDP04037OtherPHARMACY PERMIT #
MDBN8689652OtherDEA NUMBER
MDP04037OtherPHARMACY PERMIT #