NPIMap

Organization Active NPI

Park Lane Pharmacy

  • Community/Retail Pharmacy
  • Baltimore, MD
National Provider Identifier
1013072446
Registry record updated Jul 21, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
P03053 Issued in MD
Legal business name
PARK LANE PHARMACY
Practice address
4259 Park Heights Ave
Baltimore, MD 21215-6740
Phone
(410) 466-8001
Fax
(410) 466-8304
NPI assigned
Dec 26, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2016

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

Authorized official

Name
Emmanuel Bajulaiye, RPHNPI 1235795576
Title
Owner
Phone
(410) 466-8001

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X P03053 MD Primary

Addresses

Primary practice location

4259 Park Heights Ave
Baltimore, MD 21215-6740

Mailing address

4259 Park Heights Ave
Baltimore, MD 21215-6740
Phone (410) 466-8001

Other identifiers 2

IdentifierTypeStateIssuer
2036464OtherPK
382800000MedicaidMD

Other names 1

  • PARK LANE PHARMACY INC Doing business as

National Provider Directory

National Provider Directory

Locations

4259 Park Heights Ave
Baltimore, MD 21215
Phone (410) 466-8001

Practitioners & affiliated clinicians

Practitioners 2

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": "1167091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1469059200000",
    "number": "1013072446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4259 PARK HEIGHTS AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212156740",
            "telephone_number": "410-466-8001",
            "fax_number": "410-466-8304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4259 PARK HEIGHTS AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212156740",
            "telephone_number": "410-466-8001",
            "fax_number": "410-466-8304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARK LANE PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-26",
        "last_updated": "2016-07-21",
        "status": "A",
        "authorized_official_last_name": "BAJULAIYE",
        "authorized_official_first_name": "EMMANUEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "410-466-8001",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MD",
            "license": "P03053",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2036464",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "382800000",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PARK LANE PHARMACY INC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2016; 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.