Organization
JOHN WAYNE PHARMACY LLC
Active
Organization
JOHN WAYNE PHARMACY LLC
Active
Other names
PROFESSIONAL PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN WAYNE PD (PHARMACIST AND OWNER)
(410) 687-8113
Entity
Organization
Contact information
Practice address
9106 PHILADELPHIA RD, STE 100, BALTIMORE, MD 21237-4329
(410) 687-8113
(410) 391-3922
Mailing address
844 RITCHIE HWY STE 208, SEVERNA PARK, MD 21146-4137
(410) 294-3884
(410) 544-0774
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
P04404
MD
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
011018300
—
MD
01
—
2034379
PK
—
Enumeration date
06/13/2006
Last updated
11/16/2016
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