Provider Demographics
NPI:1932385515
Name:WHITEMARSH PHARMACY
Entity Type:Organization
Organization Name:WHITEMARSH PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:N
Authorized Official - Last Name:SOURANIS
Authorized Official - Suffix:
Authorized Official - Credentials:PD
Authorized Official - Phone:410-633-5050
Mailing Address - Street 1:4924 CAMPBELL BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-5908
Mailing Address - Country:US
Mailing Address - Phone:443-384-2500
Mailing Address - Fax:443-384-2525
Practice Address - Street 1:4924 CAMPBELL BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-5908
Practice Address - Country:US
Practice Address - Phone:443-384-2500
Practice Address - Fax:443-384-2525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDPO4046332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5130750001Medicare NSC