Provider Demographics
NPI:1427698257
Name:MEDVENTURE PARTNERS LLC
Entity type:Organization
Organization Name:MEDVENTURE PARTNERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:KUNJAL
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:215-990-4540
Mailing Address - Street 1:1912 LIBERTY RD SPC 21
Mailing Address - Street 2:
Mailing Address - City:SYKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21784-6690
Mailing Address - Country:US
Mailing Address - Phone:443-899-4775
Mailing Address - Fax:443-899-4776
Practice Address - Street 1:4000 MITCHELLVILLE RD STE 406
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-3104
Practice Address - Country:US
Practice Address - Phone:443-899-4775
Practice Address - Fax:443-899-4776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-09
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4104481OtherMARYLAND DEPT OF HEALTH (OCSA) - OFFICE OF CONTROLLED SUBSTANCES ADMINISTRATION
MDP08180OtherPHARMACY PERMIT