Organization
NUTRIVENE PHARMACY GROUP INC
Active
Other names
OAKDALE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
JANICE HUPPMANN (MANAGER)
(410) 474-7320
Entity
Organization
Contact information
Practice address
1713 EDMONDSON AVE, CATONSVILLE, MD 21228-4346
(410) 747-7320
(410) 719-7951
Mailing address
1713 EDMONDSON AVE, CATONSVILLE, MD 21228-4346
(410) 747-7320
(410) 719-7951
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
P00474
MD
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
055203800
—
MD
01
—
2125082
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
06/08/2006
Last updated
10/20/2010
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