Provider Demographics
NPI:1285803718
Name:EAGLE PHARMACY INC
Entity type:Organization
Organization Name:EAGLE PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:GLADYS
Authorized Official - Middle Name:
Authorized Official - Last Name:MONGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-442-2050
Mailing Address - Street 1:2470 LONGSTONE LN
Mailing Address - Street 2:UNIT G
Mailing Address - City:MARRIOTTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21104-1510
Mailing Address - Country:US
Mailing Address - Phone:410-442-2050
Mailing Address - Fax:410-442-2053
Practice Address - Street 1:2470 LONGSTONE LN
Practice Address - Street 2:UNIT G
Practice Address - City:MARRIOTTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21104-1510
Practice Address - Country:US
Practice Address - Phone:410-442-2050
Practice Address - Fax:410-442-2053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP047263336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2038352OtherPK