Provider Demographics
NPI:1770520017
Name:PARADIGM PHARMACY LLC
Entity type:Organization
Organization Name:PARADIGM PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LEON
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:VANDENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:410-729-2131
Mailing Address - Street 1:408 HEADQUARTERS DR
Mailing Address - Street 2:SUITE 5
Mailing Address - City:MILLERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21108-2550
Mailing Address - Country:US
Mailing Address - Phone:410-729-2131
Mailing Address - Fax:410-729-1118
Practice Address - Street 1:408 HEADQUARTERS DR
Practice Address - Street 2:SUITE 5
Practice Address - City:MILLERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21108-2550
Practice Address - Country:US
Practice Address - Phone:410-729-2131
Practice Address - Fax:410-729-1118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDPW0212183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDMK48OtherBLUE CROSS BLUE SHIELD
MDF869OtherFEP
MD4437780001Medicare ID - Type Unspecified