MEDICARE: NEW ERA CARE PHARMACY AND VARIETY OUTLET

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0004X	Compounding Pharmacy
2	333600000X	Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2037840	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275664104
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW ERA CARE PHARMACY AND VARIETY OUTLET

Provider Business Mailing Address
First Line	:	1436 ADDISON RD S
Second Line	:
City	:	CAPITOL HEIGHTS
State	:	MD
Zip	:	20743-4413
Country	:	US
Telephone Number	:	301-808-4361
Fax Number	:	301-808-5291

Provider Business Practice Location Address
First Line	:	1436 ADDISON RD S
Second Line	:
City	:	CAPITOL HEIGHTS
State	:	MD
Zip	:	20743-4413
Country	:	US
Telephone Number	:	301-808-4361
Fax Number	:	301-808-5291

Authorized Official
Title or Position	:	CEO
Name	:	MRS. SELINA NWACHUKWU
Credential	:	PHARMD
Telephone Number	:	301-808-4361

Provider Enumeration Date	:	03/09/2007
Last Update Date	:	11/15/2024

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