Healthcare Provider Details

I. General information

NPI: 1003692682
Provider Name (Legal Business Name): MEDACCESS PHARMACY SVC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2023
Last Update Date: 10/20/2023
Certification Date: 10/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7350 VAN DUSEN RD STE 120
LAUREL MD
20707-5267
US

IV. Provider business mailing address

7350 VAN DUSEN RD STE 120
LAUREL MD
20707-5267
US

V. Phone/Fax

Practice location:
  • Phone: 301-604-8500
  • Fax:
Mailing address:
  • Phone: 301-604-8500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. EJIKE IZUNDU UNEGBU
Title or Position: MANAGER
Credential: PHARMD
Phone: 301-604-8500