Organization
PARK LANE PHARMACY
Active
Other names
PARK LANE PHARMACY INC
Organization subpart
No
Provider details
NPI number
Authorized official
EMMANUEL BAJULAIYE RPH (OWNER)
(410) 466-8001
Entity
Organization
Contact information
Practice address
4259 PARK HEIGHTS AVE, BALTIMORE, MD 21215-6740
(410) 466-8001
(410) 466-8304
Mailing address
4259 PARK HEIGHTS AVE, BALTIMORE, MD 21215-6740
(410) 466-8001
(410) 466-8304
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
P03053
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2036464
PK
—
05
—
382800000
—
MD
Enumeration date
12/26/2006
Last updated
07/21/2016
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