Provider Demographics
NPI:1891849915
Name:FAIRLAND MARKET INC.
Entity Type:Organization
Organization Name:FAIRLAND MARKET INC.
Other - Org Name:MCKAY'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORPORATE SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:CHERRY
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-373-5848
Mailing Address - Street 1:PO BOX 98
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:20636-0098
Mailing Address - Country:US
Mailing Address - Phone:301-373-5848
Mailing Address - Fax:301-373-5338
Practice Address - Street 1:37670 MOHAWK DR
Practice Address - Street 2:BOX 169
Practice Address - City:CHARLOTTE HALL
Practice Address - State:MD
Practice Address - Zip Code:20622-0169
Practice Address - Country:US
Practice Address - Phone:301-884-3561
Practice Address - Fax:301-884-0365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP01019183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD2112631OtherNCPDP
MD2112631OtherNABP
MDAM2401432OtherDEA
MD2112631OtherNABP