Healthcare Provider Details

I. General information

NPI: 1972549483
Provider Name (Legal Business Name): CHARLES CARE PHARMACIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 06/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 EAST CHARLES ST
LA PLATA MD
20646-5931
US

IV. Provider business mailing address

PO BOX 1723
WESTMINSTER MD
21158-5723
US

V. Phone/Fax

Practice location:
  • Phone: 301-934-0648
  • Fax: 301-609-7816
Mailing address:
  • Phone: 410-848-9251
  • Fax: 443-639-0093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberP04344
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES A. MILLER
Title or Position: PRESIDENT
Credential:
Phone: 410-848-9251