Provider Demographics
NPI:1700476470
Name:MIDTOWN PHARMACEUTICALS, LLC
Entity Type:Organization
Organization Name:MIDTOWN PHARMACEUTICALS, LLC
Other - Org Name:MIDTOWN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:CRIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:769-305-9030
Mailing Address - Street 1:121 CONGRESSIONAL LN STE 101
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-1542
Mailing Address - Country:US
Mailing Address - Phone:240-833-3937
Mailing Address - Fax:800-709-0250
Practice Address - Street 1:121 CONGRESSIONAL LN STE 101
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-1542
Practice Address - Country:US
Practice Address - Phone:240-833-3937
Practice Address - Fax:800-709-0250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-26
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD444339000Medicaid