=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225223639
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAMILY CARE PHARMACY III INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/10/2007
-----------------------------------------------------
Last Update Date | 10/24/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6196 OXON HILL RD STE 130
-----------------------------------------------------
City | OXON HILL
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20745-3100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-839-6000
-----------------------------------------------------
Fax | 301-839-6002
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6196 OXON HILL RD STE 130
-----------------------------------------------------
City | OXON HILL
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20745-3100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-839-6000
-----------------------------------------------------
Fax | 301-839-6002
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | RX MANAGER
-----------------------------------------------------
Name | KEVIN CHOE
-----------------------------------------------------
Credential | PHARM.D.
-----------------------------------------------------
Telephone | 301-839-6000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | P04659
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------