# ANJELO MIDA INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** ANJELO MIDA INC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1902967078
- **Authorized official:** LOREEN WUTOH RPH (PHARMACY MANAGER)
- **Authorized official phone:** (410) 737-3151

## Contact information

- **Practice address:** 1502 JOH AVE, STE 100, BALTIMORE, MD 21227-1137
- **Practice address phone:** (410) 737-3151
- **Practice address fax:** (410) 737-8450
- **Mailing address:** 1502 JOH AVE, STE 100, BALTIMORE, MD 21227-1137
- **Mailing address phone:** (410) 737-3151
- **Mailing address fax:** (410) 737-8450

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | PW0203 | MD | Yes |

## Other

- **Enumeration date:** 12/13/2006
- **Last updated:** 05/20/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 000072800 | — | MD |
| 01 | — | 2125234 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |