Provider Demographics
NPI:1922339902
Name:PHARMACARE AT MT. CLARE, LLC
Entity Type:Organization
Organization Name:PHARMACARE AT MT. CLARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:REDDY
Authorized Official - Middle Name:
Authorized Official - Last Name:ANNAPPAREDDY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:443-616-6500
Mailing Address - Street 1:1100 W PRATT ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21223-2678
Mailing Address - Country:US
Mailing Address - Phone:443-512-5966
Mailing Address - Fax:443-512-8887
Practice Address - Street 1:1100 W PRATT ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21223-2678
Practice Address - Country:US
Practice Address - Phone:443-512-5966
Practice Address - Fax:443-512-8887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD139393336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy