| Organization Name: | MATTAPONY CARE PHARMACY |
| NPI Number: | 1164579215 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | WALTER ROSENBURG (OWNER AND PRES) |
| Mailing Address: | 4919 57th Ave Bladensburg |
| State: | MD US |
| Postal Code: | 207101605 |
| Phone Number: | 3017792500 |
| Fax Number: | 3016998219 |
| NPI Enumeration Date: | 01/04/2007 |
| NPI Last Update Date: | 09/12/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 3336C0004X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Pharmacy |
| Taxonomy Specialization: | Compounding Pharmacy |
| Taxonomy Definition: | A pharmacy that specializes in the preparation of components into a drug preparation as the result of a Practitioner |