Organization
WATERMONT PHARMACY
Active
Organization
WATERMONT PHARMACY
Active
Other names
WATERMONT PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
JODI LARE RPH (OWNER PHARMACIST)
(410) 465-0552
Entity
Organization
Contact information
Practice address
4900 WATERLOO RD # A, ELLICOTT CITY, MD 21043-6664
(410) 465-0552
(410) 465-0553
Mailing address
4900 WATERLOO RD # A, ELLICOTT CITY, MD 21043-6664
(410) 465-0552
(410) 465-0553
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
P00820
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
011682300
—
MD
01
—
2103896
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
06/11/2006
Last updated
04/22/2011
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