Provider Demographics
NPI:1750304648
Name:FIBUS DRUG STORE INC
Entity Type:Organization
Organization Name:FIBUS DRUG STORE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:LEVIN
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:410-947-1800
Mailing Address - Street 1:2101 GARRISON BLVD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21216-2606
Mailing Address - Country:US
Mailing Address - Phone:410-947-1800
Mailing Address - Fax:410-566-9181
Practice Address - Street 1:2101 GARRISON BLVD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21216-2606
Practice Address - Country:US
Practice Address - Phone:410-947-1800
Practice Address - Fax:410-566-9181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05749332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD54920401OtherCAREFIRST