Provider Demographics
NPI:1952642019
Name:BTCN, LLC
Entity Type:Organization
Organization Name:BTCN, LLC
Other - Org Name:DULANEY VALLEY HEALTH MART PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BERTHA
Authorized Official - Middle Name:BATE
Authorized Official - Last Name:NDJE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:410-296-4900
Mailing Address - Street 1:195 GITTINGS AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-2423
Mailing Address - Country:US
Mailing Address - Phone:410-207-2118
Mailing Address - Fax:
Practice Address - Street 1:716 DULANEY VALLEY RD
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-5109
Practice Address - Country:US
Practice Address - Phone:410-296-4900
Practice Address - Fax:410-296-4901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-13
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD6901320001Medicare NSC