Organization
WIENNER INC
Active
Other names
Mt. Vernon Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN WIENNER (PRESIDENT)
(410) 539-8030
Entity
Organization
Contact information
Practice address
900 CATHEDRAL ST, BALTIMORE, MD 21201-5311
(410) 539-8030
Mailing address
900 CATHEDRAL ST, BALTIMORE, MD 21201-5311
(410) 539-8030
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336S0011X
Specialty Pharmacy
—
—
335E00000X
Prosthetic/Orthotic Supplier
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2123254
NCPDP PROVIDER IDENTIFICATION NUMBER
MD
05
—
803001400
—
MD
Enumeration date
09/18/2014
Last updated
09/18/2014
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