| Laurel Main Street Pharmacy Incorporated | |
|
667 Main St Laurel MD 20707-4067 | |
| (301) 317-3838 | |
| (301) 317-3637 |
| Full Name | Laurel Main Street Pharmacy Incorporated |
|---|---|
| Speciality | Pharmacist |
| Location | 667 Main St, Laurel, Maryland |
| Authorized Official Name and Position | Ali H Thakkar (OWNER) |
| Authorized Official Contact | 3013173838 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Laurel Main Street Pharmacy Incorporated 667 Main St Laurel MD 20707-4067 Ph: (301) 317-3838 | Laurel Main Street Pharmacy Incorporated 667 Main St Laurel MD 20707-4067 Ph: (301) 317-3838 |
| NPI Number | 1477558112 |
|---|---|
| Provider Enumeration Date | 06/18/2005 |
| Last Update Date | 09/14/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477558112 | NPI | - | NPPES |
| 0029793 | Medicaid | MD | |
| 2132087 | Other | MD | NCPDP NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
| 183500000X | Pharmacist | 16959 (Maryland) | Primary |
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Laurel Main Street Pharmacy Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 667 Main St, Laurel, MD 20707 Phone: 301-317-3838 Fax: 301-317-3637 |