Provider Demographics
NPI:1912458381
Name:CHASE BREXTON HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:CHASE BREXTON HEALTH SERVICES, INC.
Other - Org Name:CHASE BREXTON HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:CYWINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:410-837-2050
Mailing Address - Street 1:200 HOSPITAL DR STE 300
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-5884
Mailing Address - Country:US
Mailing Address - Phone:410-837-2050
Mailing Address - Fax:443-573-5010
Practice Address - Street 1:200 HOSPITAL DR STE 300
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5884
Practice Address - Country:US
Practice Address - Phone:410-837-2050
Practice Address - Fax:443-573-5010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-20
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MD074213336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2165831OtherPK
MD507702800Medicaid