Provider Demographics
NPI:1245442854
Name:HARVARD PHARMACY INC
Entity type:Organization
Organization Name:HARVARD PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER AND RPH
Authorized Official - Prefix:
Authorized Official - First Name:TAMANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BANU
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:410-667-0336
Mailing Address - Street 1:10 WARREN RD STE 10WARREN
Mailing Address - Street 2:
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-2506
Mailing Address - Country:US
Mailing Address - Phone:410-667-0336
Mailing Address - Fax:410-667-0339
Practice Address - Street 1:10 WARREN RD STE 10WARREN
Practice Address - Street 2:
Practice Address - City:COCKEYSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21030-2506
Practice Address - Country:US
Practice Address - Phone:410-667-0336
Practice Address - Fax:410-667-0339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MDP045543336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD013041900Medicaid
2038224OtherPK