Provider Demographics
NPI:1295095875
Name:MY WEIGHT DOCTOR PHARMACY, LL
Entity type:Organization
Organization Name:MY WEIGHT DOCTOR PHARMACY, LL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YASEMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SALMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-473-6656
Mailing Address - Street 1:1701 ROCKVILLE PIKE
Mailing Address - Street 2:SUITE A12
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-1613
Mailing Address - Country:US
Mailing Address - Phone:240-430-2503
Mailing Address - Fax:240-430-2504
Practice Address - Street 1:1701 ROCKVILLE PIKE STE A12
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-1613
Practice Address - Country:US
Practice Address - Phone:240-430-2503
Practice Address - Fax:240-430-2504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-17
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336H0001X, 3336M0002X, 3336S0011X
MDPW03573336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2136605OtherNCPDP PROVIDER IDENTIFICATION NUMBER