WOODHAVEN PHARMACY LLC , NPI 1720081425 — WOODHAVEN HEALTH SERVICES in BALTIMORE (MD)

NPI 1720081425

14+ Years Experience Organization

WOODHAVEN PHARMACY LLC

Other organization name: WOODHAVEN HEALTH SERVICES.

05/27/2005
PROVIDER ENUMERATION DATE
07.09.2007
LAST UPDATE DATE
1720081425
NPI NUMBER

About WOODHAVEN PHARMACY LLC

WOODHAVEN PHARMACY LLC is a provider established in BALTIMORE, MD. The NPI number of WOODHAVEN PHARMACY LLC is 1720081425 and was assigned on 05/27/2005. The practitioners primary taxonomy code is: 333600000X with license number: 3009485 MD .

Mailing address

  • City: BALTIMORE
  • State: MD
  • Postal code: 212372309
  • Phone: 4439278400
  • Fax: 4439278465
  • Address: 9006 YELLOW BRICK RD
  • Address 2: STE F

Primary Practice Address

  • Region : BALTIMORE, MD
  • NPI : 1720081425
  • Phone : 4439278400
  • Fax : 4439278465
  • Postalcode : 212372309
  • Address : 9006 YELLOW BRICK RD STE F

Additional identifiers

  • Identifier: 4003497000
  • Code / Type : 5 - MEDICAID
  • Identifier state : MD

Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Additional identifiers # 2

  • Identifier: 2126692
  • Code / Type : 1 - other
  • Identifier state : MD
  • Identifier issuer : NCPDP

Provider taxonomy - Pharmacy

  • Taxonomy code: 333600000X
  • License number: 3009485
  • License state: MD

The taxonomy is the primary taxonomy (there can be only one per NPI record).

Taxonomy description: A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

Contacts:

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  • WOODHAVEN PHARMACY LLC
  • Address : 9006 YELLOW BRICK RD STE F
  • Region : BALTIMORE, MD
  • NPI : 1720081425
  • Phone : 4439278400
  • Fax : 4439278465
  • Postalcode : 212372309

Authorized official :

{:AUTHORIZED_OFFICIAL_FIRST_NAME:} {:AUTHORIZED_OFFICIAL_MIDDLE_NAME:} {:AUTHORIZED_OFFICIAL_LAST_NAME:}
  • Phone : 4439278474
  • Title or position : CEO

Reference NPI Information. Full replica of the CMS (NPPES) NPI record

Field Name Value
Provider First Line Business Practice Location Address9006 YELLOW BRICK RD
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Second Line Business Practice Location AddressSTE F
The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City NameBALTIMORE
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameMD
The State or Province name in the location address of the provider being identified.
Provider Business Practice Location Address Postal Code212372309
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Telephone Number4439278400
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number4439278465
The fax number associated with the location address of the provider being identified.
NPI1720081425
10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider.
Healthcare Provider Taxonomy 1333600000X
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.
Provider Enumeration Date05/27/2005
The date the provider was assigned a unique identifier (assigned an NPI).
Last Updated07.09.2007
The date that a record was last updated or changed.
Entity TypeOrganization
Code describing the type of health care provider that is being assigned an NPI. Codes are:
  • 1 = (Person): individual human being who furnishes health care;
  • 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Provider Organization Name (Legal Business Name)WOODHAVEN PHARMACY LLC
Provide organization name (legal business name used to file tax returns with the IRS). The Organization Name field allows the following special characters: ampersand, apostrophe, "at" sign, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters.
Provider Other Organization NameWOODHAVEN HEALTH SERVICES
Other name by which the organization provider is or has been known.
Provider Other Organization Name Type Code5
Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/a) name; 4 = former legal business name; 5 = other.
Provider First Line Business Mailing Address9006 YELLOW BRICK RD
The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
Provider Second Line Business Mailing AddressSTE F
The second line mailing address of the provider being identified. This data element may contain the same information as "Provider second line location address".
Provider Business Mailing Address City NameBALTIMORE
The City name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address City name".
Provider Business Mailing Address State NameMD
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
Provider Business Mailing Address Postal Code212372309
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
Provider Business Mailing Address Telephone Number4439278400
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
Provider Business Mailing Address Fax Number4439278465
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
Authorized Official Last NameHILL
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First NameBARBARA
The first name of the authorized official
Authorized Official Title or PositionCEO
The title or position of the authorized official
Authorized Official Name Prefix TextMS.
Authorized Official Name Prefix Text
Authorized Official Telephone Number4439278474
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code #1333600000X
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.
Healthcare Provider Taxonomy 1Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.
Provider License Number 13009485
Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section.
Provider License Number State Code 1MD
Healthcare Provider Primary Taxonomy Switch 1Y
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
Other Provider Identifier 14003497000
Other Provider Identifier #1
Other Provider Identifier Type 15
  • 1 - Other
  • 5 - MEDICAID
Other Provider Identifier State 1MD
Other Provider Identifier State #1
Other Provider Identifier 22126692
Other Provider Identifier #2
Other Provider Identifier Type 21
  • 1 - Other
  • 5 - MEDICAID
Other Provider Identifier State 2MD
Other Provider Identifier State #2
Other Provider Identifier Issuer 2NCPDP
Other Provider Identifier Issuer #2
X

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