Organization
OLD LINE HEALTHCARE INC
Active
Other names
POTOMAC PHARMATECH
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC SHELLEY R PH (VP OF OPERATIONS)
(717) 848-3445
Entity
Organization
Contact information
Practice address
16107A ELLIOTT PKWY, WILLIAMSPORT, MD 21795-4084
(301) 223-6616
(301) 223-6679
Mailing address
16107A ELLIOTT PKWY, WILLIAMSPORT, MD 21795-4084
(301) 223-6616
(301) 223-6679
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
MO0560293
WV
3336L0003X
Long Term Care Pharmacy
Primary
PW0296
MD
3336M0002X
Mail Order Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
012478800
—
MD
05
—
1023189160001
—
PA
01
—
2038215
PK
—
05
—
3810023127
—
WV
Enumeration date
02/02/2007
Last updated
06/16/2016
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