Organization
LAUREL MAIN STREET PHARMACY INCORPORATED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ALI H THAKKAR PHARM-D (PRESIDENT)
(301) 317-3838
Entity
Organization
Contact information
Practice address
667 MAIN ST, LAUREL, MD 20707-4067
(301) 317-3838
(301) 317-3637
Mailing address
667 MAIN ST, LAUREL, MD 20707-4067
(301) 317-3838
(301) 317-3637
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0002X
Clinic Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
P05892
MD
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0029793
—
MD
05
—
4097696
—
MD
Enumeration date
06/08/2006
Last updated
09/14/2023
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