Provider Demographics
NPI:1972581825
Name:SOMERSET HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:SOMERSET HEALTH SERVICES LLC
Other - Org Name:CRISFIELD DISCOUNT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAH
Authorized Official - Middle Name:MOHAMMED
Authorized Official - Last Name:YAHYA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:410-968-1660
Mailing Address - Street 1:390 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CRISFIELD
Mailing Address - State:MD
Mailing Address - Zip Code:21817-1329
Mailing Address - Country:US
Mailing Address - Phone:410-968-1660
Mailing Address - Fax:410-968-9102
Practice Address - Street 1:390 W MAIN ST UNIT A
Practice Address - Street 2:
Practice Address - City:CRISFIELD
Practice Address - State:MD
Practice Address - Zip Code:21817
Practice Address - Country:US
Practice Address - Phone:410-968-1660
Practice Address - Fax:410-968-9102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14326183500000X
MDP041743336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD2132051OtherNCPDP
MD408862000OtherMEDICAID DME
MD457383OtherMD. CONTROL DRUG SUBSTANC
MD003150000Medicaid
MDP04174OtherPHARMACY PERMIT
VA010166268Medicaid
VA010166268Medicaid
VA010166268Medicaid