Organization
MATTAPONY CARE PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WALTER ROSENBURG PD (OWNER AND PRES)
(301) 779-2500
Entity
Organization
Contact information
Practice address
4919 57TH AVE, BLADENSBURG, MD 20710-1605
(301) 779-2500
(301) 699-8219
Mailing address
4919 57TH AVE, BLADENSBURG, MD 20710-1605
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
P00421
MD
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2101943
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
01/04/2007
Last updated
09/12/2007
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