Provider Demographics
NPI:1922144534
Name:MT CARMEL MEDICAL INC
Entity Type:Organization
Organization Name:MT CARMEL MEDICAL INC
Other - Org Name:MT CARMEL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER-PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:EATON
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:410-357-8200
Mailing Address - Street 1:PO BOX 553
Mailing Address - Street 2:
Mailing Address - City:MONKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21111-0553
Mailing Address - Country:US
Mailing Address - Phone:410-343-0110
Mailing Address - Fax:410-343-1578
Practice Address - Street 1:111 MOUNT CARMEL RD
Practice Address - Street 2:
Practice Address - City:PARKTON
Practice Address - State:MD
Practice Address - Zip Code:21120-9706
Practice Address - Country:US
Practice Address - Phone:410-343-0110
Practice Address - Fax:410-343-1578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
MDP013033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2033918OtherPK
MD2114229Medicaid
MD2114229Medicaid