Provider Demographics
NPI:1891892725
Name:DEEP CREEK PHARMACY HERPEL PC
Entity Type:Organization
Organization Name:DEEP CREEK PHARMACY HERPEL PC
Other - Org Name:DEEP CREEK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARM/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:
Authorized Official - Last Name:HERPEL
Authorized Official - Suffix:
Authorized Official - Credentials:BS PHARM
Authorized Official - Phone:301-387-5300
Mailing Address - Street 1:PO BOX 267
Mailing Address - Street 2:
Mailing Address - City:MC HENRY
Mailing Address - State:MD
Mailing Address - Zip Code:21541-0267
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:24465 GARRETT HWY
Practice Address - Street 2:
Practice Address - City:MC HENRY
Practice Address - State:MD
Practice Address - Zip Code:21541-1326
Practice Address - Country:US
Practice Address - Phone:301-387-5300
Practice Address - Fax:301-387-4994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MDP017623336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD405852600Medicaid
2033909OtherPK
MD7568390001Medicare NSC