Healthcare Provider Details

I. General information

NPI: 1326878349
Provider Name (Legal Business Name): CHILDREN'S HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2024
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12211 PLUM ORCHARD DR STE 101
SILVER SPRING MD
20904-7903
US

IV. Provider business mailing address

12211 PLUM ORCHARD DR STE 102
SILVER SPRING MD
20904-7903
US

V. Phone/Fax

Practice location:
  • Phone: 240-531-4400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: PHILLICIA NELSON
Title or Position: EXEC DIR-PAYOR FINANCIAL RELATIONS
Credential:
Phone: 301-572-6281