Organization
NORTHERN PHCY AT OVERLEA LLC
Active
Other names
NORTHERN PHARMACY AT OVERLEA
Organization subpart
No
Provider details
NPI number
Authorized official
PEPPER MINTZ (PRESIDENT AND COO)
(410) 254-2055
Entity
Organization
Contact information
Practice address
7618 BELAIR RD, BALTIMORE, MD 21236-4088
(410) 661-1655
(410) 661-1822
Mailing address
7618 BELAIR RD, BALTIMORE, MD 21236-4088
(410) 661-1655
(410) 661-1822
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
P04147
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002883500
—
MD
01
—
2037909
PK
—
Enumeration date
07/22/2006
Last updated
08/26/2016
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