Provider Demographics
NPI:1972642247
Name:MED ONE PHARMACY INC
Entity Type:Organization
Organization Name:MED ONE PHARMACY INC
Other - Org Name:BRUNSWICK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-620-4302
Mailing Address - Street 1:610 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:MD
Mailing Address - Zip Code:21716-1828
Mailing Address - Country:US
Mailing Address - Phone:301-834-9715
Mailing Address - Fax:301-834-4414
Practice Address - Street 1:610 9TH AVE
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:MD
Practice Address - Zip Code:21716-1828
Practice Address - Country:US
Practice Address - Phone:301-834-9715
Practice Address - Fax:301-834-4414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP047183336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2034793OtherPK