Healthcare Provider Details

I. General information

NPI: 1730261520
Provider Name (Legal Business Name): GREENBELT CONSUMER COOPERATIVE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 03/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 CENTERWAY
GREENBELT MD
20770-1802
US

IV. Provider business mailing address

121 CENTERWAY
GREENBELT MD
20770-1802
US

V. Phone/Fax

Practice location:
  • Phone: 301-474-4400
  • Fax: 301-474-3736
Mailing address:
  • Phone: 301-474-4400
  • Fax: 301-474-3736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
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 NumberP01086
License Number StateMD

VIII. Authorized Official

Name: SAJIDA QAYUMI
Title or Position: PHARMACY MGR
Credential: RPH
Phone: 301-474-4400