# NORTHSIDE PHARMACY LONG TERM CARE INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1356716864
- **Authorized official:** DAVID H AYRES (PRESIDENT)
- **Authorized official phone:** (443) 207-8048

## Contact information

- **Practice address:** 707 NORTH BRIDGE STREET, SUITE C, ELKTON, MD 21921
- **Practice address phone:** (443) 207-8048
- **Practice address fax:** (443) 207-8396
- **Mailing address:** 707 NORTH BRIDGE STREET, SUITE C, ELKTON, MD 21921
- **Mailing address phone:** (443) 207-8048
- **Mailing address fax:** (443) 207-8396

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | — | MD | Yes |

## Other

- **Enumeration date:** 12/09/2015
- **Last updated:** 12/09/2015