Provider Demographics
NPI:1902127087
Name:BLUE DOOR PHARMACIES
Entity Type:Organization
Organization Name:BLUE DOOR PHARMACIES
Other - Org Name:SHADY GROVE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER/PIC
Authorized Official - Prefix:DR
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALIZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:240-731-2813
Mailing Address - Street 1:1117 10TH ST NW
Mailing Address - Street 2:SUITE 709
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-4311
Mailing Address - Country:US
Mailing Address - Phone:202-631-3812
Mailing Address - Fax:
Practice Address - Street 1:15225 SHADY GROVE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3254
Practice Address - Country:US
Practice Address - Phone:301-948-4222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-12
Last Update Date:2010-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD170343336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy