MEDICARE: QUALITY OF LIFE PHCY AND HEALTH INC

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	333600000X	Pharmacy
2	3336C0004X	Compounding Pharmacy	PW0269	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2038180	OTHER		PK

General Provider Information

NPI Number	:	1295746832
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUALITY OF LIFE PHCY AND HEALTH INC

Provider Business Mailing Address
First Line	:	8900 EDGEWORTH DR STE G
Second Line	:
City	:	CAPITOL HEIGHTS
State	:	MD
Zip	:	20743-3744
Country	:	US
Telephone Number	:	301-324-3715
Fax Number	:	301-324-3713

Provider Business Practice Location Address
First Line	:	8900 EDGEWORTH DR STE G
Second Line	:
City	:	CAPITOL HEIGHTS
State	:	MD
Zip	:	20743-3744
Country	:	US
Telephone Number	:	301-324-3715
Fax Number	:	301-324-3713

Authorized Official
Title or Position	:	PRESIDENT AND OWNER
Name	:	TERRI PETERS
Credential	:	BSCPHARM,R,PH.
Telephone Number	:	301-324-3715

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	08/23/2016

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