Healthcare Provider Details

I. General information

NPI: 1700067618
Provider Name (Legal Business Name): FRIENDLY PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2007
Last Update Date: 12/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 TOWN CENTER DR
LUSBY MD
20657
US

IV. Provider business mailing address

226 TOWN CENTER DR
LUSBY MD
20657
US

V. Phone/Fax

Practice location:
  • Phone: 410-326-2260
  • Fax: 410-326-3360
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP04671
License Number StateMD

VIII. Authorized Official

Name: VINCENT JACKSON
Title or Position: OWNER
Credential:
Phone: 301-580-3818