Ellicott City Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

P05543 Issued in MD

Legal business name

ELLICOTT CITY PHARMACY INC

Practice address

10194 Baltimore National Pike Ste 104
Ellicott City, MD 21042-3655

Phone

(410) 750-1951

Fax

(410) 750-1953

NPI assigned

Jun 24, 2011

Organization subpart

No

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

Authorized official

Name

Paul J NA, PHARM D.NPI 1144244492

Title

Officer/Manager

Phone

(410) 750-1951

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Ellicott City Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in MD

Enrollment records 1

Locations

Practitioners 4

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

• Paul J NA, PHARM D.

  • Pharmacist
  • Columbia, MD
  • NPI 1144244492
  NPD Authorized official
• Chul Ho Shin, PHARMACIST

  • Pharmacist
  • Ellicott City, MD
  • NPI 1902784127
  NPD
• CHI Su Ham, PHARMD

  • Pharmacist
  • Largo, MD
  • NPI 1225791106
  NPD (past)
• Jungeun Joan Kim, R.PH.

  • Pharmacist
  • Washington, DC
  • NPI 1982843389
  NPD (past)

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

{
    "created_epoch": "1308873600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644537600000",
    "number": "1497041768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10194 BALTIMORE NATIONAL PIKE STE 104",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210423655",
            "telephone_number": "410-750-1951",
            "fax_number": "410-750-1953"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10194 BALTIMORE NATIONAL PIKE STE 104",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210423655",
            "telephone_number": "410-750-1951",
            "fax_number": "410-750-1953"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELLICOTT CITY PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-24",
        "last_updated": "2022-02-11",
        "certification_date": "2022-02-11",
        "status": "A",
        "authorized_official_last_name": "NA",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OFFICER/MANAGER",
        "authorized_official_telephone_number": "410-750-1951",
        "authorized_official_credential": "PHARM D."
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MD",
            "license": "P05543",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2131136",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "442813700",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ellicott City Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Ellicott City Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ellicott City Health LLC
• Ellicott City Nursing and Rehab Center LLC
• Ellicott City Pediatric Assoc
• Ellicott City Pediatric Associates, PA
• Ellicott City Pharmacy Inc
• Ellicott City Primary Care LLC
• Ellicott City Primary Care Medicine PA
• Ellicott City Total Eye Care LLC
• Ellicott City Wellness Chiropractic, L.L.C.
• Ellicott City Womens Health

• Community/Retail Pharmacy in Ellicott City, MD
• Providers in Ellicott City, MD by specialty
• Community/Retail Pharmacy in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2022; 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.