Healthcare Provider Details

I. General information

NPI: 1962759316
Provider Name (Legal Business Name): CIVIC HEALTH SERVICES 2 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2012
Last Update Date: 10/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 W STEIN HWY
SEAFORD DE
19973-1203
US

IV. Provider business mailing address

337 CIVIC AVE STE 20
SALISBURY MD
21804-5231
US

V. Phone/Fax

Practice location:
  • Phone: 302-629-3737
  • Fax: 302-629-3330
Mailing address:
  • Phone: 410-749-5900
  • Fax: 410-749-5901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberP05970
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberA30000935
License Number StateDE

VIII. Authorized Official

Name: WAHEED AZIZ
Title or Position: OWNER
Credential: RPH
Phone: 410-749-5900