Provider Demographics
NPI:1336540301
Name:TARGET
Entity Type:Organization
Organization Name:TARGET
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSY
Authorized Official - Middle Name:
Authorized Official - Last Name:EDOUARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-664-4267
Mailing Address - Street 1:1040 DEER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210-2558
Mailing Address - Country:US
Mailing Address - Phone:267-664-4267
Mailing Address - Fax:
Practice Address - Street 1:1040 DEER RIDGE DR
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21210-2558
Practice Address - Country:US
Practice Address - Phone:267-664-4267
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-10
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD227383336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy