Provider Demographics
NPI:1699325787
Name:AME PHARMACY IMMUNIZATION
Entity type:Organization
Organization Name:AME PHARMACY IMMUNIZATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:IRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:HERBST
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:410-719-2020
Mailing Address - Street 1:2813 GREEN LAKE CIR
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-3859
Mailing Address - Country:US
Mailing Address - Phone:443-324-3144
Mailing Address - Fax:
Practice Address - Street 1:731 FREDERICK RD
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-4503
Practice Address - Country:US
Practice Address - Phone:410-719-2020
Practice Address - Fax:410-719-6915
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AME PHARMACY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD800431500Medicaid