LAUREL MAIN STREET PHARMACY INCORPORATED NPI 1477558112

NPI Information

NPI: 1477558112
Provider Name: LAUREL MAIN STREET PHARMACY INCORPORATED
Classification: Pharmacist - 183500000X
Entity Type: Organization
Doing Business As: MAIN STREET PHARMACY
CLIA Number: 21D2248345
Address: 667 MAIN ST
LAUREL, MD
ZIP 20707
Phone: (301) 317-3838

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NPI Details

LAUREL MAIN STREET PHARMACY INCORPORATED is a pharmacist in Laurel, MD. The provider is an individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care. LAUREL MAIN STREET PHARMACY INCORPORATED NPI is 1477558112. The provider is registered as an organization entity type.
The provider Is Doing Business As Main Street Pharmacy.

The provider's business location address is:

667 MAIN ST
LAUREL, MD
ZIP 20707-067
Phone: (301) 317-3838
Fax: (301) 317-3637

The provider's authorized official is Ali H Thakkar .
The authorized official title is Owner and has the following contact phone number (301) 317-3838.

The CLIA number assigned to this NPI record is 21D2248345 - pharmacy with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/18/2005 and was last updated on 9/14/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QP2300X	Clinic/Center	Primary Care			No
2	183500000X	Pharmacist		16959	MARYLAND	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	0029793	MEDICAID	MARYLAND
2	2132087	OTHER	MARYLAND	NCPDP NUMBER

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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