Organization
NORTHSIDE PHARMACY INC
Active
Other names
Northside Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID AYRES RPH (PRESIDENT,PIC, AO)
(410) 398-3784
Entity
Organization
Contact information
Practice address
707 N BRIDGE ST, ELKTON, MD 21921-5314
(410) 398-3784
(410) 398-3306
Mailing address
707 N BRIDGE ST, ELKTON, MD 21921-5314
(410) 398-3784
(410) 398-3306
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
P06260
MD
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
021969000
—
MD
01
—
2119888
PK
—
Enumeration date
04/28/2009
Last updated
12/01/2016
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