Menlo Pharmacy

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

P04963 Issued in MD

Legal business name

MENLO PHARMACY

Practice address

5900 Reisterstown Rd
Baltimore, MD 21215-3481

Phone

(410) 764-1112

Fax

(410) 764-1113

NPI assigned

Jan 1, 2009

Organization subpart

No

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

Authorized official

Name

Nico Mawun

Title

Owner

Phone

(703) 926-3219

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Menlo Pharmacy LLC Doing business as

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

{
    "created_epoch": "1230768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1234828800000",
    "number": "1881830453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17021 OAK HILL RD",
            "city": "SPENCERVILLE",
            "state": "MD",
            "postal_code": "208683105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5900 REISTERSTOWN RD",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212153481",
            "telephone_number": "410-764-1112",
            "fax_number": "410-764-1113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MENLO PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-01",
        "last_updated": "2009-02-17",
        "status": "A",
        "authorized_official_last_name": "MAWUN",
        "authorized_official_first_name": "NICO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "703-926-3219"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MD",
            "license": "P04963",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "2134334",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Menlo Pharmacy LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lingguo Meng, PH.D.
• Marda Menbere Mengesha
• Firehiwot Abebe Mengistie, M.D
• Amanda Menke, LCSW-C
• Abigail Menken
• Menocal Medical Services PA
• Menocal Medical Services, PA
• Aroth Srikumar Menon, M.D.
• Deepa Unnikrishnan Menon, M.D.
• Pallavi V Menon

• Community/Retail Pharmacy in Baltimore, MD
• Providers in Baltimore, 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 17, 2009; 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.