Healthcare Provider Details

I. General information

NPI: 1972170157
Provider Name (Legal Business Name): CERTIFIED HEALTHCARE PROVIDERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2021
Last Update Date: 12/14/2024
Certification Date: 12/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20140 SCHOLAR DR RM 120
HAGERSTOWN MD
21742-6501
US

IV. Provider business mailing address

1201 67TH ST STE C
ROSEDALE MD
21237-2513
US

V. Phone/Fax

Practice location:
  • Phone: 443-676-2100
  • Fax:
Mailing address:
  • Phone: 443-676-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: YIN C CHAN
Title or Position: DIRECTOR OF OPERATIONS/OWNER
Credential:
Phone: 443-300-8633