Provider Demographics
NPI:1538585773
Name:MARYLAND PHARMACY AND HOME INFUSION, INC
Entity type:Organization
Organization Name:MARYLAND PHARMACY AND HOME INFUSION, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:DORINE
Authorized Official - Middle Name:
Authorized Official - Last Name:FOBI-TAKSUI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-363-8271
Mailing Address - Street 1:10085 RED RUN BLVD
Mailing Address - Street 2:SUITE 104 B
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-4836
Mailing Address - Country:US
Mailing Address - Phone:410-363-8271
Mailing Address - Fax:410-363-8273
Practice Address - Street 1:10085 RED RUN BLVD
Practice Address - Street 2:SUITE 104 B
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-4836
Practice Address - Country:US
Practice Address - Phone:410-363-8271
Practice Address - Fax:410-363-8273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-12
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD3336H0001X, 332BP3500X, 333600000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No333600000XSuppliersPharmacy