Provider Demographics
NPI:1891049318
Name:MANCHESTER PHARMACY, INC
Entity Type:Organization
Organization Name:MANCHESTER PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:GLEESPEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:410-239-2300
Mailing Address - Street 1:PO BOX 886
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MD
Mailing Address - Zip Code:21102-0886
Mailing Address - Country:US
Mailing Address - Phone:410-239-2300
Mailing Address - Fax:
Practice Address - Street 1:3321 MAIN ST
Practice Address - Street 2:UNIT A1
Practice Address - City:MANCHESTER
Practice Address - State:MD
Practice Address - Zip Code:21102-1790
Practice Address - Country:US
Practice Address - Phone:410-239-2300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-06
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDPO4029333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy