Healthcare Provider Details

I. General information

NPI: 1679888655
Provider Name (Legal Business Name): ZONETAK HEALTHCARE AND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2010
Last Update Date: 07/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10085 RED RUN BLVD STE 104
OWINGS MILLS MD
21117-4811
US

IV. Provider business mailing address

4200 SIHLER OAKS TRL
OWINGS MILLS MD
21117-5006
US

V. Phone/Fax

Practice location:
  • Phone: 410-363-8271
  • Fax: 410-363-8273
Mailing address:
  • Phone: 410-363-8271
  • Fax: 410-363-8273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP05380
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336M0003X
TaxonomyManaged Care Organization Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: NGUEGNI FOBI-TAKUSI
Title or Position: DIRECTOR OF PHARMACY
Credential:
Phone: 410-363-8271