MEDICARE: FAMILI-CARE PHARMACY, 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	3336C0003X	Community/Retail Pharmacy	P06331	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2147560	OTHER		PK

General Provider Information

NPI Number	:	1396152054
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILI-CARE PHARMACY, INC

Provider Business Mailing Address
First Line	:	11100 LIBERTY RD
Second Line	:	SUITE D
City	:	RANDALLSTOWN
State	:	MD
Zip	:	21133-1026
Country	:	US
Telephone Number	:	443-272-6424
Fax Number	:	443-272-6425

Provider Business Practice Location Address
First Line	:	11100 LIBERTY RD STE D
Second Line	:
City	:	RANDALLSTOWN
State	:	MD
Zip	:	21133-1054
Country	:	US
Telephone Number	:	443-272-6424
Fax Number	:	443-272-6425

Authorized Official
Title or Position	:	OWNER
Name	:	LOUIS ONWUANAIBE
Credential	:
Telephone Number	:	443-272-6424

Provider Enumeration Date	:	07/15/2014
Last Update Date	:	05/01/2017

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