Healthcare Provider Details

I. General information

NPI: 1972916682
Provider Name (Legal Business Name): FOKOS GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2014
Last Update Date: 04/12/2021
Certification Date: 04/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6020 MEADOWRIDGE CENTER DR STE B
ELKRIDGE MD
21075-6528
US

IV. Provider business mailing address

6020 MEADOWRIDGE CENTER DR STE B
ELKRIDGE MD
21075-6528
US

V. Phone/Fax

Practice location:
  • Phone: 410-799-7227
  • Fax: 410-799-2660
Mailing address:
  • Phone: 410-799-7227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberP06385
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. FUNMILAYO FADINA
Title or Position: OWNER
Credential: PHARM D.
Phone: 443-904-3009