Organization
ANJELO MIDA INC
Active
Other names
ANJELO MIDA INC
Organization subpart
No
Provider details
NPI number
Authorized official
LOREEN WUTOH RPH (PHARMACY MANAGER)
(410) 737-3151
Entity
Organization
Contact information
Practice address
1502 JOH AVE, STE 100, BALTIMORE, MD 21227-1137
(410) 737-3151
(410) 737-8450
Mailing address
1502 JOH AVE, STE 100, BALTIMORE, MD 21227-1137
(410) 737-3151
(410) 737-8450
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
PW0203
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000072800
—
MD
01
—
2125234
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
12/13/2006
Last updated
05/20/2010
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