Provider Demographics
NPI:1669418026
Name:CHESAPEAKE DRUG INC
Entity type:Organization
Organization Name:CHESAPEAKE DRUG INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEO
Authorized Official - Middle Name:
Authorized Official - Last Name:MALLARD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:410-741-5150
Mailing Address - Street 1:15 E CHESAPEAKE BEACH RD
Mailing Address - Street 2:#160
Mailing Address - City:OWINGS
Mailing Address - State:MD
Mailing Address - Zip Code:20736-3517
Mailing Address - Country:US
Mailing Address - Phone:410-257-3700
Mailing Address - Fax:410-257-0540
Practice Address - Street 1:15 E CHESAPEAKE BEACH RD
Practice Address - Street 2:#160
Practice Address - City:OWINGS
Practice Address - State:MD
Practice Address - Zip Code:20736-3517
Practice Address - Country:US
Practice Address - Phone:410-257-3700
Practice Address - Fax:410-257-0540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336S0011X
MDP000553336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2033435OtherPK
MD780500400Medicaid
MD780500400Medicaid