Provider Demographics
NPI:1811207079
Name:UNION MEMORIAL HOSPITAL-PHARMACY DEPT
Entity Type:Organization
Organization Name:UNION MEMORIAL HOSPITAL-PHARMACY DEPT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:DR
Authorized Official - First Name:LIESER
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:410-554-2907
Mailing Address - Street 1:201 EAST UNIVERSITY PARKWAY
Mailing Address - Street 2:PHARMACY DEPARTMENT
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-2895
Mailing Address - Country:US
Mailing Address - Phone:410-554-2555
Mailing Address - Fax:410-554-2230
Practice Address - Street 1:201 EAST UNIVERSITY PARKWAY
Practice Address - Street 2:PHARMACY DEPARTMENT
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-2895
Practice Address - Country:US
Practice Address - Phone:410-554-2555
Practice Address - Fax:410-554-2230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP00797333600000X, 3336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No333600000XSuppliersPharmacy