Healthcare Provider Details

I. General information

NPI: 1730245002
Provider Name (Legal Business Name): BOWIE COMCARE PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 04/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15431 EXCELSIOR DR BOWIE TOWN CENTER
BOWIE MD
20716-2208
US

IV. Provider business mailing address

15431 EXCELSIOR DR BOWIE TOWN CENTER
BOWIE MD
20716-2208
US

V. Phone/Fax

Practice location:
  • Phone: 301-262-2877
  • Fax: 301-262-4488
Mailing address:
  • Phone: 301-262-2877
  • Fax: 301-262-4488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP02661
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MARIE THERESE OYALOWO
Title or Position: OWNER,PIC
Credential: RPH
Phone: 301-262-2877