Healthcare Provider Details

I. General information

NPI: 1790060317
Provider Name (Legal Business Name): BESTCARE PHARMACY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2011
Last Update Date: 05/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3061 FREDERICK AVENUE
BALTIMORE MD
21223
US

IV. Provider business mailing address

3061 FREDERICK AVENUE
BALTIMORE MD
21223
US

V. Phone/Fax

Practice location:
  • Phone: 410-566-5045
  • Fax: 410-566-5268
Mailing address:
  • Phone: 410-566-5045
  • Fax: 410-566-5268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP05566
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberP05566
License Number StateMD

VIII. Authorized Official

Name: MR. KOLAWOLE KA ADEOLA
Title or Position: OWNER
Credential:
Phone: 410-415-6505