# OLD LINE HEALTHCARE INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** POTOMAC PHARMATECH
- **Organization subpart:** No

## Provider details

- **NPI number:** 1356489348
- **Authorized official:** ERIC SHELLEY R PH (VP OF OPERATIONS)
- **Authorized official phone:** (717) 848-3445

## Contact information

- **Practice address:** 16107A ELLIOTT PKWY, WILLIAMSPORT, MD 21795-4084
- **Practice address phone:** (301) 223-6616
- **Practice address fax:** (301) 223-6679
- **Mailing address:** 16107A ELLIOTT PKWY, WILLIAMSPORT, MD 21795-4084
- **Mailing address phone:** (301) 223-6616
- **Mailing address fax:** (301) 223-6679

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | MO0560293 | WV | — |
| 3336L0003X | Long Term Care Pharmacy | PW0296 | MD | Yes |
| 3336M0002X | Mail Order Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 02/02/2007
- **Last updated:** 06/16/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 012478800 | — | MD |
| 05 | — | 1023189160001 | — | PA |
| 01 | — | 2038215 | PK | — |
| 05 | — | 3810023127 | — | WV |