Provider Demographics
NPI:1881452282
Name:PARKVIEW MARYLAND RX, LLC
Entity type:Organization
Organization Name:PARKVIEW MARYLAND RX, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WACLAWEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-876-2323
Mailing Address - Street 1:3920 MAIN ST # 100
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14226-3350
Mailing Address - Country:US
Mailing Address - Phone:716-876-2323
Mailing Address - Fax:
Practice Address - Street 1:2760 LIGHTHOUSE PT E STE 110
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-5054
Practice Address - Country:US
Practice Address - Phone:410-276-7586
Practice Address - Fax:510-276-7587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-11
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy