NPIMap

Organization Active NPI

Mt Vernon Pharmacy at Fallsway Inc

  • Community/Retail Pharmacy
  • Baltimore, MD
National Provider Identifier
1417264458
Registry record updated Mar 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
P05345 Issued in MD
Legal business name
MT VERNON PHARMACY AT FALLSWAY INC
Doing business as
Mt. Vernon Pharmacy at Fallsway
Practice address
421 Fallsway
Baltimore, MD 21202-4800
Phone
(410) 962-1100
Fax
(410) 962-1300
NPI assigned
Sep 13, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 6, 2024

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

Authorized official

Name
Stephen WiennerNPI 1033304308
Title
President
Phone
(410) 539-8030

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X P05345 MD Primary
Specialty Pharmacy 3336S0011X

Addresses

Primary practice location

421 Fallsway
Baltimore, MD 21202-4800

Mailing address

900 Cathedral St
Baltimore, MD 21201-5311
Phone (410) 539-8030

Other identifiers 2

IdentifierTypeStateIssuer
03625-8100MedicaidMD
2126651OtherPK

Other names 1

  • Mt. Vernon Pharmacy at Fallsway Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20110411000071 MD Part B Supplier - Mass Immunization (Roster Biller Only) 3779767108 Practice locations: Baltimore, MD
O20130109000229 MD DME Supplier - Pharmacy 3779767108 Practice locations: Baltimore, MD

National Provider Directory

National Provider Directory
Tax ID family
Mt Vernon Pharmacy at Falls2 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.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1284336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709683200000",
    "number": "1417264458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 CATHEDRAL ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212015311",
            "telephone_number": "410-539-8030",
            "fax_number": "410-539-8115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "421 FALLSWAY",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212024800",
            "telephone_number": "410-962-1100",
            "fax_number": "410-962-1300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MT VERNON PHARMACY AT FALLSWAY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-13",
        "last_updated": "2024-03-06",
        "certification_date": "2024-03-06",
        "status": "A",
        "authorized_official_last_name": "WIENNER",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "410-539-8030"
    },
    "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": "P05345",
            "primary": true
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03625-8100",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2126651",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mt. Vernon Pharmacy at Fallsway",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2024; 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.