Organization
CVS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER REZAKHAN (DISTRICT MANAGER)
(443) 716-5153
Entity
Organization
Contact information
Practice address
6480 OLD WATERLOO ROAD, ELKRIDGE, MD 21075
(410) 799-0291
Mailing address
8839 STONEBROOK LN, COLUMBIA, MD 21046-1415
(919) 449-6230
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
Primary
23561
MD
Other
Enumeration date
09/01/2015
Last updated
09/01/2015
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