Provider Demographics
NPI:1982009510
Name:NAYLOR LANE PHARMACY INC.
Entity Type:Organization
Organization Name:NAYLOR LANE PHARMACY INC.
Other - Org Name:WELLCARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TEMITOPE
Authorized Official - Middle Name:
Authorized Official - Last Name:GBOLAGUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-484-2105
Mailing Address - Street 1:4000 OLD COURT RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-2800
Mailing Address - Country:US
Mailing Address - Phone:410-484-2105
Mailing Address - Fax:410-484-2106
Practice Address - Street 1:4000 OLD COURT RD
Practice Address - Street 2:SUITE 101
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-2800
Practice Address - Country:US
Practice Address - Phone:410-484-2105
Practice Address - Fax:410-484-2106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-24
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty