Provider Demographics
NPI:1952477374
Name:PHARMASAP INC
Entity Type:Organization
Organization Name:PHARMASAP INC
Other - Org Name:EXTRACARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ABDULMOJEED
Authorized Official - Middle Name:ADEWALE
Authorized Official - Last Name:LAWAL
Authorized Official - Suffix:
Authorized Official - Credentials:PD
Authorized Official - Phone:410-332-4666
Mailing Address - Street 1:883 N HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-4605
Mailing Address - Country:US
Mailing Address - Phone:410-332-4666
Mailing Address - Fax:410-332-0298
Practice Address - Street 1:883 N HOWARD ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-4605
Practice Address - Country:US
Practice Address - Phone:410-332-4666
Practice Address - Fax:410-332-0298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09734183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD404419300Medicaid
MD5388420001Medicare NSC
2127288Medicare UPIN