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General NPI Number Information
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NPI Number | 1043244205
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Entity Type | Organization
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Legal Business Name | COVENANT FOOD STORES INC.
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 14633 BALTIMORE AVE
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City | LAUREL
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State | MD
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Zip | 20707-4902
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Country | US
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Telephone | 301-362-9100
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Fax | 301-362-9138
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Provider Business Mailing Address
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Address Line | 14633 BALTIMORE AVE
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City | LAUREL
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State | MD
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Zip | 20707-4902
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Country | US
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Telephone | 301-362-9100
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Fax | 301-362-9138
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Authorized Official
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Title or Position | PHARMACIST/PRESIDENT
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Name | MR. COLLINWISE OSEI-ABOAGYE
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Credential | RPH
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Telephone | 301-362-9100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | P04006
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License Number State | MD
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