Provider Demographics
NPI:1952624330
Name:PHARMACARE AT MT CLAIRE LLC
Entity type:Organization
Organization Name:PHARMACARE AT MT CLAIRE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:REDDY
Authorized Official - Middle Name:
Authorized Official - Last Name:ANNAPPAREDDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-616-6500
Mailing Address - Street 1:2227 OLD EMMORTON RD
Mailing Address - Street 2:SUITE 122
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-6187
Mailing Address - Country:US
Mailing Address - Phone:410-209-1100
Mailing Address - Fax:410-209-4500
Practice Address - Street 1:1251 W PRATT ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21223-2665
Practice Address - Country:US
Practice Address - Phone:410-209-1100
Practice Address - Fax:410-209-4500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-12
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0002X, 3336C0004X
MDP052683336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD30125600Medicaid
2135223OtherNCPDP PROVIDER IDENTIFICATION NUMBER