Provider Demographics
NPI:1942830732
Name:KLEINS BROADWAY & MAIN INC
Entity Type:Organization
Organization Name:KLEINS BROADWAY & MAIN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-420-8220
Mailing Address - Street 1:2101 ROCK SPRING RD
Mailing Address - Street 2:
Mailing Address - City:FOREST HILL
Mailing Address - State:MD
Mailing Address - Zip Code:21050-2617
Mailing Address - Country:US
Mailing Address - Phone:410-420-8224
Mailing Address - Fax:
Practice Address - Street 1:5 BEL AIR SOUTH PKWY STE 301
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-6087
Practice Address - Country:US
Practice Address - Phone:443-512-8373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-21
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD550692100Medicaid