Provider Demographics
NPI:1902985674
Name:MERGOLD INC
Entity Type:Organization
Organization Name:MERGOLD INC
Other - Org Name:HALETHORPE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER,RPH,AO
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:GARMER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:410-247-3344
Mailing Address - Street 1:1307 FRANCIS AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21227-3913
Mailing Address - Country:US
Mailing Address - Phone:410-247-3344
Mailing Address - Fax:410-247-9110
Practice Address - Street 1:1307 FRANCIS AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21227-3913
Practice Address - Country:US
Practice Address - Phone:410-247-3344
Practice Address - Fax:410-247-9110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X, 3336L0003X
MDP024233336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD345000700Medicaid
MD241004400Medicaid
2036734OtherPK
2036734OtherPK