NPIMap

Organization Active NPI

Avalon Professional Pharmacy LLC.

  • Community/Retail Pharmacy
  • Glenn Dale, MD
National Provider Identifier
1003681016
Registry record updated Nov 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
AVALON PROFESSIONAL PHARMACY LLC.
Practice address
12100 Annapolis Rd Unit 2
Glenn Dale, MD 20769
Phone
(301) 383-0142
Fax
(301) 383-0143
NPI assigned
Nov 20, 2023
Organization subpart
Yes
Parent organization
AVALON MARKETING INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 20, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Jason C Maduka, RPHNPI 1831499292
Title
Pharmacy Owner/Pharmacy Manager
Phone
(310) 383-0142

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

12100 Annapolis Rd Unit 2
Glenn Dale, MD 20769

Mailing address

12100 Annapolis Rd Unit 2
Glenn Dale, MD 20769
Phone (301) 383-0142

Other identifiers 1

IdentifierTypeStateIssuer
456105800MedicaidMD

National Provider Directory

National Provider Directory
Tax ID family
Avalon Professional Pharmacy LLC2 organizations share this tax ID, including this one
Part of
Avalon Marketing Inc

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1700438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1700438400000",
    "number": "1003681016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12100 ANNAPOLIS RD UNIT 2",
            "city": "GLENN DALE",
            "state": "MD",
            "postal_code": "20769",
            "telephone_number": "301-383-0142",
            "fax_number": "301-383-0143"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12100 ANNAPOLIS RD UNIT 2",
            "city": "GLENN DALE",
            "state": "MD",
            "postal_code": "20769",
            "telephone_number": "301-383-0142",
            "fax_number": "301-383-0143"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVALON PROFESSIONAL PHARMACY LLC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "AVALON MARKETING INC",
        "enumeration_date": "2023-11-20",
        "last_updated": "2023-11-20",
        "status": "A",
        "authorized_official_last_name": "MADUKA",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PHARMACY OWNER/PHARMACY MANAGER",
        "authorized_official_telephone_number": "310-383-0142",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "456105800",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glenn Dale, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.