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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