Provider Demographics
NPI:1841232550
Name:ANNAPOLIS PROFESSIONAL PHARMACY INC
Entity Type:Organization
Organization Name:ANNAPOLIS PROFESSIONAL PHARMACY INC
Other - Org Name:ANNAPOLIS PROFESSIONAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:PD
Authorized Official - Phone:410-263-7440
Mailing Address - Street 1:703 GIDDINGS AVE STE L1
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-1471
Mailing Address - Country:US
Mailing Address - Phone:410-263-7440
Mailing Address - Fax:410-269-5947
Practice Address - Street 1:703 GIDDINGS AVE STE L1
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-1471
Practice Address - Country:US
Practice Address - Phone:410-263-7440
Practice Address - Fax:410-269-5947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0003X
MDP00970333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2112136OtherOTHER ID NUMBER-COMMERCIAL NUMBER
MD259542700Medicaid
MD2112136Medicaid
MD259542700Medicaid