Provider Demographics
NPI:1891898722
Name:NORTHERN PHARMACY AND MEDICAL EQUIPMENT, INC
Entity Type:Organization
Organization Name:NORTHERN PHARMACY AND MEDICAL EQUIPMENT, INC
Other - Org Name:NORTHERN SPECIAL CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND COO
Authorized Official - Prefix:
Authorized Official - First Name:PEPPER
Authorized Official - Middle Name:K
Authorized Official - Last Name:MINTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-254-2055
Mailing Address - Street 1:6701 HARFORD RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-7721
Mailing Address - Country:US
Mailing Address - Phone:410-254-2055
Mailing Address - Fax:410-843-7743
Practice Address - Street 1:6703-6705 HARFORD RD.
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21234-7707
Practice Address - Country:US
Practice Address - Phone:410-254-2055
Practice Address - Fax:410-843-7743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDPW02453336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD411651800Medicaid