NPIMap

Organization Active NPI

John Wayne Pharmacy LLC

  • Pharmacist
  • Baltimore, MD
National Provider Identifier
1417354085
Registry record updated Nov 26, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
MD11499 Issued in MD
Legal business name
JOHN WAYNE PHARMACY LLC
Practice address
9106 Philadelphia Road
Suite #100
Baltimore, MD 21237
Phone
(410) 687-8113
Fax
(410) 391-3922
NPI assigned
Nov 26, 2014
Organization subpart
Yes
Parent organization
JOHN WAYNE PHARMACY LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 26, 2014

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

Authorized official

Name
Mr. Wayne D. Vanwie, P.D.
Title
Pharmacist/Owner
Phone
(410) 687-8113

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PharmacistGroup: 193400000X SINGLE SPECIALTY GROUP 183500000X MD11499 MD Primary

Addresses

Primary practice location

9106 Philadelphia Road
Suite #100
Baltimore, MD 21237

Mailing address

9106 Philadelphia Road
Suite #100
Baltimore, MD 21237
Phone (410) 687-8113

Other identifiers 1

IdentifierTypeStateIssuer
700301300MedicaidMD

Other names 1

  • Professional Pharmacy Doing business as

National Provider Directory

National Provider Directory
Tax ID family
John Wayne Pharmacy LLC2 organizations share this tax ID, including this one
Part of
John Wayne Pharmacy LLC

Other organizations with this tax ID 1

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

NPI Registry JSON

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

{
    "created_epoch": "1416960000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1416960000000",
    "number": "1417354085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9106 PHILADELPHIA ROAD",
            "address_2": "SUITE #100",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "21237",
            "telephone_number": "410-687-8113",
            "fax_number": "410-391-3922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9106 PHILADELPHIA ROAD",
            "address_2": "SUITE #100",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "21237",
            "telephone_number": "410-687-8113",
            "fax_number": "410-391-3922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN WAYNE PHARMACY LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "JOHN WAYNE PHARMACY LLC",
        "enumeration_date": "2014-11-26",
        "last_updated": "2014-11-26",
        "status": "A",
        "authorized_official_last_name": "VANWIE",
        "authorized_official_first_name": "WAYNE",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "PHARMACIST/OWNER",
        "authorized_official_telephone_number": "410-687-8113",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "P.D."
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pharmacist",
            "state": "MD",
            "license": "MD11499",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "700301300",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Professional Pharmacy",
            "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 Nov 26, 2014; 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.