Organization
MENLO PHARMACY
Active
Other names
Menlo Pharmacy LLC
Organization subpart
No
Provider details
NPI number
Authorized official
NICO MAWUN (OWNER)
(703) 926-3219
Entity
Organization
Contact information
Practice address
5900 REISTERSTOWN RD, BALTIMORE, MD 21215-3481
(410) 764-1112
(410) 764-1113
Mailing address
17021 OAK HILL RD, SPENCERVILLE, MD 20868-3105
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
P04963
MD
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2134334
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
01/01/2009
Last updated
02/17/2009
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