Provider Demographics
NPI:1396573838
Name:ALPHA HEALTHCARE LLC
Entity type:Organization
Organization Name:ALPHA HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:CLEMENT
Authorized Official - Middle Name:ADEBOYE
Authorized Official - Last Name:ADEBAYO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-453-9383
Mailing Address - Street 1:3061 FREDERICK AVE APT C
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21223-2758
Mailing Address - Country:US
Mailing Address - Phone:443-453-9383
Mailing Address - Fax:
Practice Address - Street 1:3061 FREDERICK AVE APT C
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21223-2758
Practice Address - Country:US
Practice Address - Phone:443-453-9383
Practice Address - Fax:443-453-9483
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALPHA HEALTHCARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy