Organization
VD & SR PHARMACY LLC
Active
Other names
PARK AVENUE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
SYAM POTLURI RPH (MANAGING MEMBER)
(443) 823-3350
Entity
Organization
Contact information
Practice address
1535 PARK AVE, BALTIMORE, MD 21217-4280
(410) 225-0800
(410) 523-3434
Mailing address
1535 PARK AVE, BALTIMORE, MD 21217-4280
(410) 225-0800
(410) 523-3434
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
P06708
MD
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2150056
PK
—
05
—
991042600
—
MD
Enumeration date
10/20/2006
Last updated
02/15/2017
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