Provider Demographics
NPI:1740394725
Name:CATONSVILE P A PHARMACY INC
Entity Type:Organization
Organization Name:CATONSVILE P A PHARMACY INC
Other - Org Name:PROFESSIONAL ARTS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SIMEON
Authorized Official - Middle Name:
Authorized Official - Last Name:GEORGIOU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-200-1200
Mailing Address - Street 1:2015 LORD BALTIMORE DR
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21244-2558
Mailing Address - Country:US
Mailing Address - Phone:443-200-1200
Mailing Address - Fax:443-200-1209
Practice Address - Street 1:2015 LORD BALTIMORE DR
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21244-2558
Practice Address - Country:US
Practice Address - Phone:443-200-1200
Practice Address - Fax:443-200-1209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MDP010223336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2033771OtherPK
MD269331300Medicaid