Organization
LAUREL MAIN STREET PHARMACY INCORPORATED
Active
Other names
Main Street Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
ALI H THAKKAR (OWNER)
(301) 317-3838
Entity
Organization
Contact information
Practice address
667 MAIN ST, LAUREL, MD 20707-4067
(301) 317-3838
(301) 317-3637
Mailing address
667 MAIN ST, LAUREL, MD 20707-4067
(301) 317-3838
(301) 317-3637
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
16959
MD
261QP2300X
Primary Care Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0029793
—
MD
01
—
2132087
NCPDP NUMBER
MD
Enumeration date
06/18/2005
Last updated
09/14/2023
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