Provider Demographics
NPI:1356711568
Name:NAISATURN
Entity type:Organization
Organization Name:NAISATURN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:STOCK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:410-919-1000
Mailing Address - Street 1:232 CYPRESS RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-1922
Mailing Address - Country:US
Mailing Address - Phone:410-703-5374
Mailing Address - Fax:
Practice Address - Street 1:1451 RITCHIE HWY
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MD
Practice Address - Zip Code:21012-2557
Practice Address - Country:US
Practice Address - Phone:410-919-1000
Practice Address - Fax:410-757-0242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-30
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09859305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service