Provider Demographics
NPI:1366905580
Name:LUSBY PHARMACY LLC
Entity type:Organization
Organization Name:LUSBY PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:TAYE
Authorized Official - Middle Name:J
Authorized Official - Last Name:OJIFINNI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-342-8209
Mailing Address - Street 1:11870 HG TRUEMAN RD
Mailing Address - Street 2:
Mailing Address - City:LUSBY
Mailing Address - State:MD
Mailing Address - Zip Code:20657-2999
Mailing Address - Country:US
Mailing Address - Phone:443-342-8209
Mailing Address - Fax:443-342-8210
Practice Address - Street 1:11870 HG TRUEMAN RD
Practice Address - Street 2:
Practice Address - City:LUSBY
Practice Address - State:MD
Practice Address - Zip Code:20657-2999
Practice Address - Country:US
Practice Address - Phone:443-342-8209
Practice Address - Fax:443-342-8210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-14
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP08070OtherMARYLAND BOARD OF PHARMACY PERMIT NUMBER