The Pavilion Corporation

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

P02225 Issued in MD

Legal business name

THE PAVILION CORPORATION

Practice address

453 E 28TH St
Baltimore, MD 21218-4426

Phone

(410) 467-4471

Fax

(410) 467-4553

NPI assigned

Jun 19, 2006

Organization subpart

No

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

Authorized official

Name

Adesola Hakeem Otubanjo

Title

Pic

Phone

(410) 467-4471

Specialties & licenses 4

Addresses

Other identifiers 2

Other names 1

• WAVERLY PROFESSIONAL PHARMACY Doing business as

Locations

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

{
    "created_epoch": "1150675200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1268265600000",
    "number": "1194760520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "453 E 28TH ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212184426",
            "telephone_number": "410-467-4471",
            "fax_number": "410-467-4553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "453 E 28TH ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212184426",
            "telephone_number": "410-467-4471",
            "fax_number": "410-467-4553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE PAVILION CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-19",
        "last_updated": "2010-03-11",
        "status": "A",
        "authorized_official_last_name": "OTUBANJO",
        "authorized_official_first_name": "ADESOLA",
        "authorized_official_middle_name": "HAKEEM",
        "authorized_official_title_or_position": "PIC",
        "authorized_official_telephone_number": "410-467-4471"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MD",
            "license": "P02225",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "014402900",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER",
            "identifier": "2122404",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WAVERLY PROFESSIONAL PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• All providers in Baltimore, MD
• Community/Retail Pharmacy in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2010; 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.