Healthcare Provider Details

I. General information

NPI: 1134651821
Provider Name (Legal Business Name): HOPE-WELL PHARMACY FREDERICK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2017
Last Update Date: 04/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W PATRICK ST
FREDERICK MD
21701-4855
US

IV. Provider business mailing address

EXPRESS PHARMACY #6 117 IVY HILL DR
MIDDLETOWN MD
21769
US

V. Phone/Fax

Practice location:
  • Phone: 240-815-6229
  • Fax: 240-815-6239
Mailing address:
  • Phone: 301-676-5876
  • Fax: 240-490-8280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP07504
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2168620
Identifier TypeOTHER
Identifier State
Identifier IssuerPK
# 2
Identifier120245600
Identifier TypeMEDICAID
Identifier StateMD
Identifier Issuer

VIII. Authorized Official

Name: TRUNG VU
Title or Position: PRESIDENT
Credential:
Phone: 301-676-5876