Provider Demographics
NPI:1760582928
Name:UNIVERSITY OF MARYLAND MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:UNIVERSITY OF MARYLAND MEDICAL CENTER, LLC
Other - Org Name:UMMC PHARMACY AT REDWOOD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:SPRINKEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-328-1501
Mailing Address - Street 1:11 S PACA ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1791
Mailing Address - Country:US
Mailing Address - Phone:410-328-5243
Mailing Address - Fax:410-328-2920
Practice Address - Street 1:11 SOUTH PACA STREET
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1734
Practice Address - Country:US
Practice Address - Phone:410-328-5243
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP01944183500000X
332B00000X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes333600000XSuppliersPharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD2120789OtherNCPDP NUMBER
MD203601100Medicaid
MDP08858OtherLICENSE
MDBU4782644OtherDEA NUMBER