Provider Demographics
NPI:1972852812
Name:SHALOM PHARMACY AND MEDICAL SUPPLIES LLC
Entity Type:Organization
Organization Name:SHALOM PHARMACY AND MEDICAL SUPPLIES LLC
Other - Org Name:SHALOM PHARMACY AND MEDICAL SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AYODELE
Authorized Official - Middle Name:
Authorized Official - Last Name:AREWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-868-4094
Mailing Address - Street 1:8981 WOODYARD RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-4203
Mailing Address - Country:US
Mailing Address - Phone:301-868-4094
Mailing Address - Fax:301-868-4049
Practice Address - Street 1:8981 WOODYARD RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-4203
Practice Address - Country:US
Practice Address - Phone:301-868-4094
Practice Address - Fax:301-868-4049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-06
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
MD059013336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2138000OtherPK