1497702203 NPI number — CHARLES CARE PHARMACY LLC

Table of content: (NPI 1497702203)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497702203 NPI number — CHARLES CARE PHARMACY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHARLES CARE PHARMACY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ANCHOR PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497702203
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/27/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1750
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MECHANICSVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23116-0005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-848-9851
Provider Business Mailing Address Fax Number:
443-639-0093

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11355 PEMBROOKE SQ
Provider Second Line Business Practice Location Address:
STE 109
Provider Business Practice Location Address City Name:
WALDORF
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20603-4805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-932-4200
Provider Business Practice Location Address Fax Number:
301-870-7581
Provider Enumeration Date:
05/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MURPHY
Authorized Official First Name:
SHANNON
Authorized Official Middle Name:
Authorized Official Title or Position:
OPERATIONS MANAGER
Authorized Official Telephone Number:
410-848-9251

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PO1327 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 405217000 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2127529 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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