Organization
ELLICOTT CITY PHARMACY INC
Active
Other names
Ellicott City Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL J NA PHARM D. (OFFICER/MANAGER)
(410) 750-1951
Entity
Organization
Contact information
Practice address
10194 BALTIMORE NATIONAL PIKE STE 104, ELLICOTT CITY, MD 21042-3655
(410) 750-1951
(410) 750-1953
Mailing address
10194 BALTIMORE NATIONAL PIKE STE 104, ELLICOTT CITY, MD 21042-3655
(410) 750-1951
(410) 750-1953
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
P05543
MD
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2131136
PK
—
05
—
442813700
—
MD
Enumeration date
06/24/2011
Last updated
02/11/2022
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