Organization
EASTERN AVENUE PHARMACY AND MEDICAL EQUIPMENT, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ADJARHO EGBEGBADIA (MANAGER)
(410) 929-8455
Entity
Organization
Contact information
Practice address
5901 EASTERN AVE, D, BALTIMORE, MD 21224
(410) 929-8455
(410) 929-8368
Mailing address
5901 EASTERN AVE., SUITE D, BALTIMORE, MD 21224-2731
(410) 929-8455
(410) 929-8368
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
P06257
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P06257
MDBOP
MD
Enumeration date
09/27/2013
Last updated
04/23/2014
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