Active NPI
Cardinal Health Pharmacy Services, LLC
- Community/Retail Pharmacy
- Oakland, MD
National Provider Identifier
1013386663
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- P06891
- Legal business name
- CARDINAL HEALTH PHARMACY SERVICES, LLC
- Practice address
- 1027 Memorial Dr
Suite 100
Oakland, MD 21550-4343 - Phone
- (301) 245-7002
- Fax
- (614) 652-4305
- NPI assigned
- Sep 24, 2015
- Organization subpart
- Yes
- Parent organization
- CARDINAL HEALTH PHARMACY SERVICES, LLC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Michael Brown
- Title
- Vice President, Managed Services
- Phone
- (281) 749-4764
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | P06891 | MD | Primary |
Addresses
Primary practice location
1027 Memorial Dr
Suite 100
Oakland, MD 21550-4343
Mailing address
13651 Dublin CT
Stafford, TX 77477-4317
Phone (281) 749-4000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2154185 | Other | PK |
Other names 1
- Mountain Laurel Community Pharmacy
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MD
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20161019001362 | MD | Part B Supplier - Mass Immunization (Roster Biller Only) | 2062707169 | Practice locations: Oakland, MD |
National Provider Directory
National Provider Directory- Tax ID family
- Pharmacy Services LLC
- Part of
- Pharmacy Services LLC
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Community/Retail Pharmacy
- Valencia, CA
- NPI 1366889362
Member organizations 9
Organizations listed as members of this organization in the National Provider Directory.
Locations
1027 Memorial Dr
Ste 100
Oakland, MD 21550
Phone (301) 245-7002
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1443052800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1714003200000",
"number": "1013386663",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13651 DUBLIN CT",
"city": "STAFFORD",
"state": "TX",
"postal_code": "774774317",
"telephone_number": "281-749-4000",
"fax_number": "614-652-0326"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1027 MEMORIAL DR",
"address_2": "SUITE 100",
"city": "OAKLAND",
"state": "MD",
"postal_code": "215504343",
"telephone_number": "301-245-7002",
"fax_number": "614-652-4305"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CARDINAL HEALTH PHARMACY SERVICES, LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "CARDINAL HEALTH PHARMACY SERVICES, LLC",
"enumeration_date": "2015-09-24",
"last_updated": "2024-04-25",
"certification_date": "2023-12-01",
"status": "A",
"authorized_official_last_name": "BROWN",
"authorized_official_first_name": "MICHAEL",
"authorized_official_title_or_position": "VICE PRESIDENT, MANAGED SERVICES",
"authorized_official_telephone_number": "281-749-4764"
},
"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": "P06891",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "2154185",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Mountain Laurel Community Pharmacy",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Mountain Laurel Community Pharmacy",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Oakland, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.