Healthcare Provider Details

I. General information

NPI: 1487927026
Provider Name (Legal Business Name): COMMUNITY CARE RX INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2012
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11801 FINGERBOARD RD STE 6
MONROVIA MD
21770-9030
US

IV. Provider business mailing address

11801 FINGERBOARD RD SUITE 6
MONROVIA MD
21770-9030
US

V. Phone/Fax

Practice location:
  • Phone: 301-882-7370
  • Fax: 301-882-7368
Mailing address:
  • Phone: 301-882-7370
  • Fax: 301-882-7368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH05655
License Number StateMD

VIII. Authorized Official

Name: MR. LEON JOHN MICAN JR.
Title or Position: OWNER
Credential:
Phone: 301-882-7370