Provider Demographics
NPI:1174620009
Name:RITCHIE PHARMACY LLC
Entity type:Organization
Organization Name:RITCHIE PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:WIELAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-355-3610
Mailing Address - Street 1:5507 RITCHIE HWY STE B
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21225-3472
Mailing Address - Country:US
Mailing Address - Phone:410-355-3610
Mailing Address - Fax:410-355-7248
Practice Address - Street 1:5507 RITCHIE HWY STE B
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21225-3472
Practice Address - Country:US
Practice Address - Phone:410-355-3610
Practice Address - Fax:410-355-7248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MDP074473336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2167211OtherPK
MD305612100Medicaid