Provider Demographics
NPI:1194270611
Name:MASTERS SPECILTIES LLC
Entity type:Organization
Organization Name:MASTERS SPECILTIES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:EMEKA
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:MUNONYE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:310-489-9982
Mailing Address - Street 1:1100 W PATRICK ST STE A
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-3903
Mailing Address - Country:US
Mailing Address - Phone:240-651-5966
Mailing Address - Fax:240-578-4980
Practice Address - Street 1:1100 W PATRICK ST STE A
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-3903
Practice Address - Country:US
Practice Address - Phone:240-651-5966
Practice Address - Fax:240-578-4980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-25
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19022261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service