Provider Demographics
NPI:1831467240
Name:PHARMACARE AT PARK HEIGHTS LLC
Entity Type:Organization
Organization Name:PHARMACARE AT PARK HEIGHTS LLC
Other - Org Name:PHARMACARE DISCOUNT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CAITLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BIEMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-377-4678
Mailing Address - Street 1:2227 OLD EMMORTON RD
Mailing Address - Street 2:SUITE 122
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-6187
Mailing Address - Country:US
Mailing Address - Phone:443-512-8966
Mailing Address - Fax:443-512-8887
Practice Address - Street 1:4412-14 PARK HEIGHTS AVENUE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215
Practice Address - Country:US
Practice Address - Phone:410-466-4500
Practice Address - Fax:410-367-2500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-13
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336S0011X
MDP056053336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD445400600Medicaid
2136287OtherNCPDP PROVIDER IDENTIFICATION NUMBER