Provider Demographics
NPI:1700983632
Name:WHITEFORD DARLINGTON, LLC
Entity type:Organization
Organization Name:WHITEFORD DARLINGTON, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NAVEEN
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:KUNAPARAJU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-457-5521
Mailing Address - Street 1:1115 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DARLINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:21034-1405
Mailing Address - Country:US
Mailing Address - Phone:410-457-5521
Mailing Address - Fax:410-457-9144
Practice Address - Street 1:1115 MAIN ST
Practice Address - Street 2:
Practice Address - City:DARLINGTON
Practice Address - State:MD
Practice Address - Zip Code:21034-1405
Practice Address - Country:US
Practice Address - Phone:410-457-5521
Practice Address - Fax:410-457-9144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDPO71233336C0003X
MDP015983336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD741030100Medicaid
2117390OtherNCPDP PROVIDER IDENTIFICATION NUMBER
MD1284420001Medicare NSC