Provider Demographics
NPI:1699184705
Name:PEMBROOKE HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:PEMBROOKE HEALTH SERVICES LLC
Other - Org Name:PEMBROOKE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:HABASHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-932-7900
Mailing Address - Street 1:4515 CENTENNIAL LN
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-6301
Mailing Address - Country:US
Mailing Address - Phone:443-528-1010
Mailing Address - Fax:
Practice Address - Street 1:11355 PEMBROOKE SQ UNIT 100
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-4805
Practice Address - Country:US
Practice Address - Phone:443-528-1010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-04
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy