Healthcare Provider Details

I. General information

NPI: 1659315851
Provider Name (Legal Business Name): FAMILY CARE PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 10/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8610 BALTIMORE WASHINGTON BLVD SUITE 110
JESSUP MD
20794
US

IV. Provider business mailing address

8610 BALTIMORE WASHINGTON BLVD SUITE 110
JESSUP MD
20794
US

V. Phone/Fax

Practice location:
  • Phone: 301-483-0795
  • Fax: 301-483-0797
Mailing address:
  • Phone: 301-483-0795
  • Fax: 301-483-0797

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 TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP07312
License Number StateMD

VIII. Authorized Official

Name: EDWARD BURCH
Title or Position: PRESIDENT
Credential:
Phone: 301-332-3845