# AVALON PROFESSIONAL PHARMACY LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** AVALON MARKETING INC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1790564417
- **Legal business name:** AVALON MARKETING INC
- **Authorized official:** MR. JASON C MADUKA RPH (PHARMACY OWNER/PHARMACY MANAGER)
- **Authorized official phone:** (301) 383-0142

## Contact information

- **Practice address:** 12100 ANNAPOLIS RD UNIT 2, GLENN DALE, MD 20769
- **Practice address phone:** (301) 383-0142
- **Practice address fax:** (301) 383-0143
- **Mailing address:** 12100 ANNAPOLIS RD UNIT 2, GLENN DALE, MD 20769
- **Mailing address phone:** (301) 383-0142
- **Mailing address fax:** (301) 383-0143

## Taxonomy

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

## Other

- **Enumeration date:** 09/22/2023
- **Last updated:** 12/08/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 456105800 | — | MD |