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Organization
ANJELO MIDA INC
Active
Organization
ANJELO MIDA INC
Active
Other names
ANJELO MIDA INC
Organization subpart
No
Provider details
NPI number
Authorized official
LOREEN WUTOH RPH (PHARMACY MANAGER)
(410) 737-3151
Entity
Organization
Contact information
Practice address
1502 JOH AVE, STE 100, BALTIMORE, MD 21227-1137
(410) 737-3151
(410) 737-8450
Mailing address
1502 JOH AVE, STE 100, BALTIMORE, MD 21227-1137
(410) 737-3151
(410) 737-8450
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
PW0203
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000072800
—
MD
01
—
2125234
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
12/13/2006
Last updated
05/20/2010
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