Provider Demographics
NPI:1073508271
Name:VOSHELL'S PHARMACY, INC
Entity type:Organization
Organization Name:VOSHELL'S PHARMACY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TRIEU
Authorized Official - Middle Name:
Authorized Official - Last Name:BAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-644-8400
Mailing Address - Street 1:3455 WILKENS AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-5213
Mailing Address - Country:US
Mailing Address - Phone:410-644-8400
Mailing Address - Fax:410-368-5110
Practice Address - Street 1:3455 WILKENS AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-5213
Practice Address - Country:US
Practice Address - Phone:410-644-8400
Practice Address - Fax:410-368-5110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-13
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
MDP009413336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2033789OtherPK
MD095902200Medicaid