Provider Demographics
NPI:1336774363
Name:PADONIA VILLAGE PHARMACY
Entity type:Organization
Organization Name:PADONIA VILLAGE PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIANA
Authorized Official - Middle Name:ATIENO
Authorized Official - Last Name:OGOLLA
Authorized Official - Suffix:
Authorized Official - Credentials:MSC PHARMACIST
Authorized Official - Phone:410-292-9038
Mailing Address - Street 1:17 ALICEVIEW CT
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-3370
Mailing Address - Country:US
Mailing Address - Phone:410-292-9038
Mailing Address - Fax:
Practice Address - Street 1:17 E PADONIA RD
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-2306
Practice Address - Country:US
Practice Address - Phone:410-292-9038
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-10
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy