Provider Demographics
NPI:1720043581
Name:MEDSTAR PHARMACIES, INC.
Entity Type:Organization
Organization Name:MEDSTAR PHARMACIES, INC.
Other - Org Name:MEDSTAR PHARMACY AT UNION MEMORIAL HOSPITAL
Other - Org Type:Other Name
Authorized Official - Title/Position:PHARMACY SERVICES MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:SARACINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-540-4492
Mailing Address - Street 1:7379 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-6329
Mailing Address - Country:US
Mailing Address - Phone:410-540-4492
Mailing Address - Fax:410-579-8264
Practice Address - Street 1:201 E UNIVERSITY PKWY
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-2829
Practice Address - Country:US
Practice Address - Phone:410-554-2557
Practice Address - Fax:410-554-2440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-17
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDPO2070333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2122024OtherNCPDP
MD0603360004Medicare ID - Type Unspecified