Healthcare Provider Details

I. General information

NPI: 1356706758
Provider Name (Legal Business Name): HOPE-WELL PHARMACY CLEVELAND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2015
Last Update Date: 02/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S CLEVELAND AVE STE 101
HAGERSTOWN MD
21740-5758
US

IV. Provider business mailing address

117 IVY HILL DR
MIDDLETOWN MD
21769-8135
US

V. Phone/Fax

Practice location:
  • Phone: 240-513-6991
  • Fax: 240-513-6992
Mailing address:
  • Phone: 301-676-5876
  • Fax: 240-513-6992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberP07062
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

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