Organization · NPI-2

Laurel Main Street Pharmacy Incorporated

Pharmacy, Community/Retail Pharmacy · Laurel, MD

NPI number1023058690
StatusActive
Last updated in NPPESSep 14, 2023

Details

NPI
1023058690
Entity type
Organization (NPI-2)
Legal business name
Laurel Main Street Pharmacy Incorporated
Organization subpart
No
Enumeration date
Jun 8, 2006
Certification date
Sep 14, 2023
Last updated
Sep 14, 2023

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
3336C0003X Pharmacy, Community/Retail PharmacyP05892MDYes
3336L0003X Pharmacy, Long Term Care Pharmacy––
261QP2300X Clinic/Center, Primary Care––
332B00000X Durable Medical Equipment & Medical Supplies––
3336C0002X Pharmacy, Clinic Pharmacy––

Practice location

667 Main St
Laurel, MD 20707-4067

Phone 301-317-3838 · Fax 301-317-3637

Mailing address

667 Main St
Laurel, MD 20707-4067

Phone 301-317-3838 · Fax 301-317-3637

Other practice locations

667 Main St
Laurel, MD 20707-4067

Phone 301-317-3838 · Fax 301-317-3637

Authorized official

Ali H Thakkar
President
3013173838

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