Provider Demographics
NPI:1881735082
Name:MID-ATLANTIC PHARMACY, LLC
Entity type:Organization
Organization Name:MID-ATLANTIC PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:T
Authorized Official - Last Name:COPELAND
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:410-641-0036
Mailing Address - Street 1:9715 HEALTHWAY DR
Mailing Address - Street 2:P.O. BOX 829
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811-3500
Mailing Address - Country:US
Mailing Address - Phone:410-641-0036
Mailing Address - Fax:410-641-0033
Practice Address - Street 1:9715 HEALTHWAY DR
Practice Address - Street 2:POB 829
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-3500
Practice Address - Country:US
Practice Address - Phone:410-641-0036
Practice Address - Fax:410-641-0033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP031413336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy