Provider Demographics
NPI:1689000135
Name:CONNET PHARMACY, LLC
Entity type:Organization
Organization Name:CONNET PHARMACY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/CEO
Authorized Official - Prefix:
Authorized Official - First Name:NORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:OSIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-522-0009
Mailing Address - Street 1:510 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21231-2912
Mailing Address - Country:US
Mailing Address - Phone:410-522-0009
Mailing Address - Fax:410-522-0005
Practice Address - Street 1:510 S BROADWAY
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21231-2912
Practice Address - Country:US
Practice Address - Phone:410-522-0009
Practice Address - Fax:410-522-0005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-16
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MDP062133336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2144508OtherPK
MD5934087 00Medicaid