Provider Demographics
NPI:1265513386
Name:CLEAR SPRING PHARMACY INC
Entity type:Organization
Organization Name:CLEAR SPRING PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:P
Authorized Official - Last Name:ALESHIRE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:301-842-2803
Mailing Address - Street 1:34 MULBERRY ST
Mailing Address - Street 2:PO BOX 190
Mailing Address - City:CLEAR SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:21722-0190
Mailing Address - Country:US
Mailing Address - Phone:301-842-2803
Mailing Address - Fax:301-842-2784
Practice Address - Street 1:34 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:CLEAR SPRING
Practice Address - State:MD
Practice Address - Zip Code:21722-0190
Practice Address - Country:US
Practice Address - Phone:301-842-2803
Practice Address - Fax:301-842-2784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDPO20533336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1187750001Medicare NSC