Provider Demographics
NPI:1174595870
Name:NORTHERN PHARMACY AND MEDICAL EQUIPMENT
Entity type:Organization
Organization Name:NORTHERN PHARMACY AND MEDICAL EQUIPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:D
Authorized Official - Last Name:LANGE
Authorized Official - Suffix:
Authorized Official - Credentials:CPHT
Authorized Official - Phone:410-254-2055
Mailing Address - Street 1:6701 HARFORD RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-7707
Mailing Address - Country:US
Mailing Address - Phone:410-254-2055
Mailing Address - Fax:
Practice Address - Street 1:6701 HARFORD RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21234-7707
Practice Address - Country:US
Practice Address - Phone:410-254-2055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-06
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP01182261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health