Provider Demographics
NPI:1912026493
Name:REDNER'S MARKETS, INC.
Entity Type:Organization
Organization Name:REDNER'S MARKETS, INC.
Other - Org Name:REDNER'S PHARMACY #27
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST-MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ASLAM
Authorized Official - Middle Name:
Authorized Official - Last Name:PERVAIZ
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:410-679-3804
Mailing Address - Street 1:1002 JOPPA FARM RD
Mailing Address - Street 2:
Mailing Address - City:JOPPA
Mailing Address - State:MD
Mailing Address - Zip Code:21085-3604
Mailing Address - Country:US
Mailing Address - Phone:410-679-3804
Mailing Address - Fax:410-679-3806
Practice Address - Street 1:1002 JOPPA FARM RD
Practice Address - Street 2:
Practice Address - City:JOPPA
Practice Address - State:MD
Practice Address - Zip Code:21085-3604
Practice Address - Country:US
Practice Address - Phone:410-679-3804
Practice Address - Fax:410-679-3806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD013396500Medicaid
MD0997350005Medicare NSC