Organization
MT VERNON PHARMACY AT FALLSWAY INC
Active
Other names
Mt. Vernon Pharmacy at Fallsway
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN WIENNER (PRESIDENT)
(410) 539-8030
Entity
Organization
Contact information
Practice address
421 FALLSWAY, BALTIMORE, MD 21202-4800
(410) 962-1100
(410) 962-1300
Mailing address
900 CATHEDRAL ST, BALTIMORE, MD 21201-5311
(410) 539-8030
(410) 539-8115
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
P05345
MD
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03625-8100
—
MD
01
—
2126651
PK
—
Enumeration date
09/13/2010
Last updated
03/06/2024
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