Old Line Healthcare Inc – Long Term Care Pharmacy

Key facts

NPI: 1356489348
Entity type: Organization (NPI type 2)
Primary specialty: Long Term Care Pharmacy 3336L0003X
License: PW0296 (MD)
Legal business name: OLD LINE HEALTHCARE INC
Practice address: 16107A Elliott Pkwy
Williamsport, MD 21795-4084
Phone: (301) 223-6616
Fax: (301) 223-6679
NPI assigned: Feb 2, 2007
Organization subpart: No

Authorized official

Name: Eric Shelley, R PH
Title: VP of Operations
Phone: (717) 848-3445

National Provider Directory

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Pharmacy	333600000X	MO0560293	WV
Long Term Care Pharmacy	3336L0003X	PW0296	MD	Yes
Mail Order Pharmacy	3336M0002X

Addresses

Primary practice location

16107A Elliott Pkwy
Williamsport, MD 21795-4084

Mailing address

16107A Elliott Pkwy
Williamsport, MD 21795-4084
Phone (301) 223-6616

Other identifiers

Identifier	Type	State	Issuer
3810023127	Medicaid	WV
1023189160001	Medicaid	PA
012478800	Medicaid	MD
2038215	Other		PK

Other names

POTOMAC PHARMATECH Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jun 16, 2016.

{
    "created_epoch": "1170374400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1466035200000",
    "number": "1356489348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16107A ELLIOTT PKWY",
            "city": "WILLIAMSPORT",
            "state": "MD",
            "postal_code": "217954084",
            "telephone_number": "301-223-6616",
            "fax_number": "301-223-6679"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16107A ELLIOTT PKWY",
            "city": "WILLIAMSPORT",
            "state": "MD",
            "postal_code": "217954084",
            "telephone_number": "301-223-6616",
            "fax_number": "301-223-6679"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLD LINE HEALTHCARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-02",
        "last_updated": "2016-06-16",
        "status": "A",
        "authorized_official_last_name": "SHELLEY",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "VP OF OPERATIONS",
        "authorized_official_telephone_number": "717-848-3445",
        "authorized_official_credential": "R PH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "WV",
            "license": "MO0560293",
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "MD",
            "license": "PW0296",
            "primary": true
        },
        {
            "code": "3336M0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Mail Order Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810023127",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1023189160001",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "012478800",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2038215",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "POTOMAC PHARMATECH",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Williamsport, MD

All providers in Williamsport, MD · Long Term Care Pharmacy in Maryland

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 16, 2016. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.