Organization · NPI-2
Laurel Main Street Pharmacy
Pharmacy, Long Term Care Pharmacy · Laurel, MD
NPI number1043968530
StatusActive
Last updated in NPPESMay 20, 2025
Details
- NPI
- 1043968530
- Entity type
- Organization (NPI-2)
- Legal business name
- Laurel Main Street Pharmacy
- Organization subpart
- No
- Enumeration date
- Mar 14, 2022
- Certification date
- May 20, 2025
- Last updated
- May 20, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 3336L0003X | Pharmacy, Long Term Care Pharmacy | – | – | Yes |
| 261QP2300X | Clinic/Center, Primary Care | – | – | |
| 3336C0002X | Pharmacy, Clinic Pharmacy | – | – | |
| 3336C0003X | Pharmacy, Community/Retail Pharmacy | – | – | |
| 3336C0004X | Pharmacy, Compounding Pharmacy | – | – |
Other names
- Main Street Pharmacy (Doing Business As)
Practice location
667 Main StLaurel, MD 20707-4067
Phone 301-317-3838 · Fax 301-317-3637
Mailing address
667 Main StLaurel, MD 20707-4067
Phone 301-317-3838 · Fax 301-317-3637
Authorized official
Ali H Thakkar
Owner
3013173838
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