Provider Demographics
NPI:1104049311
Name:COLUMBIA MED SERVICES
Entity type:Organization
Organization Name:COLUMBIA MED SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-290-6599
Mailing Address - Street 1:9693 GERWIG LN STE R
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-2837
Mailing Address - Country:US
Mailing Address - Phone:410-290-6599
Mailing Address - Fax:410-290-8874
Practice Address - Street 1:9693 GERWIG LN STE R
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-2837
Practice Address - Country:US
Practice Address - Phone:410-290-6599
Practice Address - Fax:410-290-8874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDPW0263333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD2132380OtherNCPDP