Healthcare Provider Details

I. General information

NPI: 1598543381
Provider Name (Legal Business Name): TECOYA FARRAKHAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2023
Last Update Date: 09/21/2023
Certification Date: 09/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 BENTLEY STATION CT
PARKTON MD
21120-9533
US

IV. Provider business mailing address

PO BOX 513
PARKTON MD
21120
US

V. Phone/Fax

Practice location:
  • Phone: 443-286-2045
  • Fax: 443-491-3394
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16604
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1835N1003X
TaxonomyNutrition Support Pharmacist
License Number16604
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number16604
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number16604
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: