Provider Demographics
NPI:1649470220
Name:PARTNERS PHARMACY OF MARYLAND LLC
Entity type:Organization
Organization Name:PARTNERS PHARMACY OF MARYLAND LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT OF COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:JODY
Authorized Official - Middle Name:
Authorized Official - Last Name:FENELON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-985-4873
Mailing Address - Street 1:8910 ROUTE 108
Mailing Address - Street 2:SUITE C
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-2151
Mailing Address - Country:US
Mailing Address - Phone:410-910-9260
Mailing Address - Fax:410-740-0146
Practice Address - Street 1:8910 ROUTE 108
Practice Address - Street 2:SUITE C
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2151
Practice Address - Country:US
Practice Address - Phone:410-910-9260
Practice Address - Fax:410-740-0146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-20
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDPW03043336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2133510OtherNCPDP PROVIDER IDENTIFICATION NUMBER
1649470220OtherNPPES
2133510OtherNCPDP PROVIDER IDENTIFICATION NUMBER