Provider Demographics
NPI:1861540817
Name:CHESAPEAKE DRUG INC
Entity type:Organization
Organization Name:CHESAPEAKE DRUG INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MNGR
Authorized Official - Prefix:
Authorized Official - First Name:LEO
Authorized Official - Middle Name:
Authorized Official - Last Name:MALLARD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:301-855-7554
Mailing Address - Street 1:7955 BAYSIDE RD
Mailing Address - Street 2:310
Mailing Address - City:CHESAPEAK BCH
Mailing Address - State:MD
Mailing Address - Zip Code:20732-3112
Mailing Address - Country:US
Mailing Address - Phone:410-257-2050
Mailing Address - Fax:410-257-6683
Practice Address - Street 1:7955 BAYSIDE RD
Practice Address - Street 2:310
Practice Address - City:CHESAPEAK BCH
Practice Address - State:MD
Practice Address - Zip Code:20732-3112
Practice Address - Country:US
Practice Address - Phone:410-257-2050
Practice Address - Fax:410-257-6683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336S0011X
MDP011923336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2114027OtherNCPDP PROVIDER IDENTIFICATION NUMBER
MD405862300Medicaid
0501560001Medicare NSC