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General NPI Number Information
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NPI Number | 1437494416
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Entity Type | Organization
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Legal Business Name | FORT LINCOLN PHARMACY & MEDICAL EQUIPMENT, LLC
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Dates
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Enumeration Date | 12/03/2012
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Last Update Date | 12/03/2012
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Provider Practice Location Address
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Address Line | 3180 BLADENSBURG RD. N.E.
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City | WASHINGTON
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State | DC
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Zip | 20018
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Country | US
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Telephone | 202-269-0000
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Fax | 202-269-0100
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Provider Business Mailing Address
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Address Line | 3180 BLADENSBURG RD. N.E.
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City | WASHINGTON
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State | DC
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Zip | 20018
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Country | US
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Telephone | 202-269-0000
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Fax | 202-269-0100
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Authorized Official
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Title or Position | PRESIDENT
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Name | ENOCK ADEWUYI
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Credential |
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Telephone | 202-269-0000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | RX1200023
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License Number State | DC
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