Provider Demographics
NPI:1710288360
Name:BELTSVILLE PHARMACY
Entity Type:Organization
Organization Name:BELTSVILLE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR / PHARMACIST IN CHARGE
Authorized Official - Prefix:MRS
Authorized Official - First Name:RAKHI
Authorized Official - Middle Name:
Authorized Official - Last Name:DE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:301-595-5939
Mailing Address - Street 1:5421 TALON CT
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21029-1142
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10820 RHODE ISLAND AVE STE F
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-2570
Practice Address - Country:US
Practice Address - Phone:301-595-5939
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-13
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD6689980001Medicare NSC