Mattapony Care Pharmacy

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

P00421 Issued in MD

Legal business name

MATTAPONY CARE PHARMACY

Practice address

4919 57TH Ave
Bladensburg, MD 20710-1605

Phone

(301) 779-2500

Fax

(301) 699-8219

NPI assigned

Jan 4, 2007

Organization subpart

No

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

Authorized official

Name

Walter Rosenburg, PD

Title

Owner and Pres

Phone

(301) 779-2500

Specialties & licenses 3

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1189555200000",
    "number": "1164579215",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4919 57TH AVE",
            "city": "BLADENSBURG",
            "state": "MD",
            "postal_code": "207101605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4919 57TH AVE",
            "city": "BLADENSBURG",
            "state": "MD",
            "postal_code": "207101605",
            "telephone_number": "301-779-2500",
            "fax_number": "301-699-8219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MATTAPONY CARE PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-04",
        "last_updated": "2007-09-12",
        "status": "A",
        "authorized_official_last_name": "ROSENBURG",
        "authorized_official_first_name": "WALTER",
        "authorized_official_title_or_position": "OWNER AND PRES",
        "authorized_official_telephone_number": "301-779-2500",
        "authorized_official_credential": "PD"
    },
    "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": "P00421",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "2101943",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER",
            "identifier": "2101943",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elisabeth Longtchi
• Winkler Boma Lum-Azah, HHA
• Lilian Malukeh
• Valery A Mangoh
• Dauda Alimamy Mansaray
• Jacob N Mba
• Rena Bertille Ti Mbah
• Richard Abang Mbaku
• Emeline Mbanwei
• Elvis Mbeng Ngwedjang

• Community/Retail Pharmacy in Bladensburg, MD
• Providers in Bladensburg, 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 12, 2007; 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.