Provider Demographics
NPI:1265049647
Name:WEST NORTH PHARMACY, INC
Entity type:Organization
Organization Name:WEST NORTH PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:OMOLARA
Authorized Official - Middle Name:O
Authorized Official - Last Name:ADEOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-677-7130
Mailing Address - Street 1:3044 W NORTH AVE STE A&B
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21216-3180
Mailing Address - Country:US
Mailing Address - Phone:443-873-6184
Mailing Address - Fax:443-885-9952
Practice Address - Street 1:3044 W NORTH AVE STE A&B
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21216-3180
Practice Address - Country:US
Practice Address - Phone:443-873-6184
Practice Address - Fax:443-885-9952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD63140256Medicaid