Provider Demographics
NPI:1891770632
Name:FELDMAN'S MEDICAL CENTER PHARMACY, INC.
Entity Type:Organization
Organization Name:FELDMAN'S MEDICAL CENTER PHARMACY, INC.
Other - Org Name:FELDMAN'S DORSEY HALL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:FELDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:410-730-8200
Mailing Address - Street 1:9501 OLD ANNAPOLIS RD
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-6314
Mailing Address - Country:US
Mailing Address - Phone:410-730-8200
Mailing Address - Fax:410-730-8092
Practice Address - Street 1:9501 OLD ANNAPOLIS RD
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-6314
Practice Address - Country:US
Practice Address - Phone:410-730-8200
Practice Address - Fax:410-730-8092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP01534333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0787200001Medicare NSC