Provider Demographics
NPI:1740232354
Name:MEDSTAR PHARMACIES, INC.
Entity Type:Organization
Organization Name:MEDSTAR PHARMACIES, INC.
Other - Org Name:MEDSTAR PHARMACY AT WHC
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER, CENTRAL PHARMACY SUPPORT
Authorized Official - Prefix:
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 1:106 IRVING ST NW
Practice Address - Street 2:SUITE 1200
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2927
Practice Address - Country:US
Practice Address - Phone:202-877-6309
Practice Address - Fax:202-877-8473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRX88001333336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC0904347OtherNCPDP#
DC024723900Medicaid
DC024723900Medicaid