Waverly Professional Pharmacy

LBN: The Pavilion Corporation
Waverly Professional Pharmacy is an health care organization with primary practice located at 453 E 28Th St , Baltimore MD 21218-4426. The organization recently has 4 registered licenses in different health care specialties including Suppliers / Durable Medical Equipment & Medical Supplies, Suppliers / Pharmacy, Suppliers / Community/Retail Pharmacy, Suppliers / Compounding Pharmacy. Suppliers / Community/Retail Pharmacy is the primary health care specialty. The Pavilion Corporation can be contacted via phone (410) 467-4471, or through Otubanjo, Adesola Hakeem via phone (410) 467-4471.

Contact Information

Primary practice address
453 E 28Th St Baltimore MD 21218-4426
Phone: (410) 467-4471
Fax: (410) 467-4553
Website:
Map and Directions
Authorized official contact:
Name: Otubanjo, Adesola Hakeem
Phone: (410) 467-4471

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Durable Medical Equipment & Medical Supplies 332B00000X
Suppliers / Pharmacy 333600000X
Suppliers / Community/Retail Pharmacy 3336C0003X P02225 Maryland
Suppliers / Compounding Pharmacy 3336C0004X

Profile Details

NPI number 1194760520
LBN Legal business name The Pavilion Corporation
DBA Doing business as Waverly Professional Pharmacy
Authorized official Otubanjo, Adesola Hakeem
Entity Organization
Organization subpart 1 No
Enumeration date Jun 19th, 2006
Last updated Mar 11th, 2010 - about 16 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1194760520 NPPES
Maryland MEDICAID 014402900
Maryland Other 2122404

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