Shoprite of Liberty Heights, LLC

Primary specialty

Clinic PharmacyTaxonomy code 3336C0002X

Legal business name

SHOPRITE OF LIBERTY HEIGHTS, LLC

Practice address

4601 Liberty Heights Ave
Baltimore, MD 21207-7553

Phone

(410) 367-1850

NPI assigned

Jan 21, 2020

Organization subpart

No

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

Authorized official

Name

Frank Robert Henderson

Title

Pharmacy Director

Phone

(410) 420-8220

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Shoprite of Liberty Heights LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Shoprite of Liberty Heights, LLC

  • Community/Retail Pharmacy
  • Baltimore, MD
  • NPI 1942620091
  NPD tax ID

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

{
    "created_epoch": "1579564800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579564800000",
    "number": "1306476106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2101 ROCK SPRING RD",
            "city": "FOREST HILL",
            "state": "MD",
            "postal_code": "210502617",
            "telephone_number": "410-420-8224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4601 LIBERTY HEIGHTS AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212077553",
            "telephone_number": "410-367-1850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHOPRITE OF LIBERTY HEIGHTS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-21",
        "last_updated": "2020-01-21",
        "certification_date": "2020-01-21",
        "status": "A",
        "authorized_official_last_name": "HENDERSON",
        "authorized_official_first_name": "FRANK",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "PHARMACY DIRECTOR",
        "authorized_official_telephone_number": "410-420-8220"
    },
    "taxonomies": [
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "079663800",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Olufunmilayo Sholola
• Kathryne Shomali
• Mansur E. Shomali, M.D.
• Brianna Nicole Shontz, OTR/L
• Daniella Shoob
• Shoprite of Liberty Heights, LLC
• Nava Shor
• Catherine Shorb
• Eliora Shore
• Kristin Shoresman

• Clinic Pharmacy in Baltimore, MD
• Providers in Baltimore, MD by specialty
• Clinic Pharmacy in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2020; 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.