Provider Demographics
NPI:1689669939
Name:COLUMBIA CHEMISTS LLC
Entity Type:Organization
Organization Name:COLUMBIA CHEMISTS LLC
Other - Org Name:FELDMANS MEDICAL CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VENKATA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-964-8444
Mailing Address - Street 1:11055 LITTLE PATUXENT PKWY
Mailing Address - Street 2:SUITE L-5
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-2896
Mailing Address - Country:US
Mailing Address - Phone:410-964-8444
Mailing Address - Fax:410-740-1377
Practice Address - Street 1:11055 LITTLE PATUXENT PKWY
Practice Address - Street 2:SUITE L-5
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2896
Practice Address - Country:US
Practice Address - Phone:410-964-8444
Practice Address - Fax:410-740-1377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-13
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP06963333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD419332600Medicaid
2123810OtherPK
FC5634147OtherDEA
MD419332600Medicaid