Provider Demographics
NPI:1780620252
Name:GEORGES CREEK PHARMACY INC
Entity type:Organization
Organization Name:GEORGES CREEK PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:RITCHIE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:301-463-5757
Mailing Address - Street 1:19 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LONACONING
Mailing Address - State:MD
Mailing Address - Zip Code:21539-1122
Mailing Address - Country:US
Mailing Address - Phone:301-463-5757
Mailing Address - Fax:301-463-5124
Practice Address - Street 1:19 MAIN ST
Practice Address - Street 2:
Practice Address - City:LONACONING
Practice Address - State:MD
Practice Address - Zip Code:21539-1122
Practice Address - Country:US
Practice Address - Phone:301-463-5757
Practice Address - Fax:301-463-5124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MDP008963336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2111728OtherNCPDP PROVIDER IDENTIFICATION NUMBER
MD772902200Medicaid