Laurel Main Street Pharmacy Incorporated

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

P05892 Issued in MD

Legal business name

LAUREL MAIN STREET PHARMACY INCORPORATED

Practice address

667 Main St
Laurel, MD 20707-4067

Phone

(301) 317-3838

Fax

(301) 317-3637

NPI assigned

Jun 8, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Ali H Thakkar, PHARM-D

Title

President

Phone

(301) 317-3838

Specialties & licenses 5

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in DC, MD3 enrollments

Enrollment records 3

Tax ID family

Laurel Main Street Pharmacy Incorporated3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

• Laurel Main Street Pharmacy

  • Long Term Care Pharmacy
  • Laurel, MD
  • NPI 1043968530
  NPD tax ID
• Laurel Main Street Pharmacy Incorporated

  • Pharmacist
  • Laurel, MD
  • NPI 1477558112
  NPD tax ID

Locations

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

{
    "created_epoch": "1149724800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694649600000",
    "number": "1023058690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "667 MAIN ST",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "207074067",
            "telephone_number": "301-317-3838",
            "fax_number": "301-317-3637"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "667 MAIN ST",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "207074067",
            "telephone_number": "301-317-3838",
            "fax_number": "301-317-3637"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "667 Main St",
            "address_purpose": "LOCATION",
            "city": "Laurel",
            "state": "MD",
            "postal_code": "207074067",
            "country_code": "US",
            "telephone_number": "301-317-3838",
            "fax_number": "301-317-3637",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LAUREL MAIN STREET PHARMACY INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-08",
        "last_updated": "2023-09-14",
        "certification_date": "2023-09-14",
        "status": "A",
        "authorized_official_last_name": "THAKKAR",
        "authorized_official_first_name": "ALI",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "301-317-3838",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PHARM-D"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MD",
            "license": "P05892",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0029793",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4097696",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Laurel Main Street Pharmacy
• Laurel Main Street Pharmacy Incorporated
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• Laurel Medical Associates, LLC
• Laurel Medical Center Pharmacy Inc
• Laurel Orthopedic & Medical Supplies, Inc

• Community/Retail Pharmacy in Laurel, MD
• Providers in Laurel, MD by specialty
• Community/Retail Pharmacy in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2023; 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.

Verify at the official NPI Registry.