Provider Demographics
NPI:1740216951
Name:NATILYS PHARMACY LLC
Entity Type:Organization
Organization Name:NATILYS PHARMACY LLC
Other - Org Name:PIKESVILLE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:LEO
Authorized Official - Middle Name:
Authorized Official - Last Name:FREEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:410-653-8888
Mailing Address - Street 1:4001-A SEVEN MILE LANE
Mailing Address - Street 2:STE B
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4001-A SEVEN MILE LANE
Practice Address - Street 2:STE B
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208
Practice Address - Country:US
Practice Address - Phone:410-653-8888
Practice Address - Fax:410-581-0100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP043523336C0003X
3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2132582OtherNCPDP PROVIDER IDENTIFICATION NUMBER
MD006045300Medicaid
MD006045300Medicaid