Organization
CHARLESMEAD FOUNTAIN PHARMCY LLC
Active
Organization
CHARLESMEAD FOUNTAIN PHARMCY LLC
Active
Other names
Charlesmead Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MITCHELL KROMSKY (OWNER)
(410) 823-1818
Entity
Organization
Contact information
Practice address
6242 BELLONA AVE, BALTIMORE, MD 21212-2445
(410) 435-0210
(410) 323-5025
Mailing address
6240 BELLONA AVE, BALTIMORE, MD 21212-2408
(410) 435-0210
(410) 323-5025
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
P06964
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2154754
PK
—
05
—
547107900
—
MD
Enumeration date
09/20/2006
Last updated
02/03/2016
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