Provider Demographics
NPI:1720450406
Name:BELAIR PHARMACY LLC
Entity Type:Organization
Organization Name:BELAIR PHARMACY LLC
Other - Org Name:BELAIR PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:BUKOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:AJIBADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-601-3136
Mailing Address - Street 1:5309 BELAIR RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21206-5109
Mailing Address - Country:US
Mailing Address - Phone:410-601-3136
Mailing Address - Fax:443-522-7481
Practice Address - Street 1:5309 BELAIR RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21206-5109
Practice Address - Country:US
Practice Address - Phone:410-601-3136
Practice Address - Fax:443-522-7481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-21
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336L0003X
MDP069533336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy