Provider Demographics
NPI:1124285754
Name:JOHNS HOPKINS OP PHCY AT ELDER PLUS
Entity type:Organization
Organization Name:JOHNS HOPKINS OP PHCY AT ELDER PLUS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OP PHCY
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH MBA
Authorized Official - Phone:410-288-8022
Mailing Address - Street 1:PO BOX 630646
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21263-0646
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4940 EASTERN AVE
Practice Address - Street 2:RMHE 137 MASON F LORD BLDG E TWR
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-2735
Practice Address - Country:US
Practice Address - Phone:410-550-5354
Practice Address - Fax:410-550-7864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP044383336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2132897OtherOTHER ID NUMBER