=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457731671
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIFE CARE PHARMACY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/03/2015
-----------------------------------------------------
Last Update Date | 12/30/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5429 REISTERTOWN ROAD
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-869-6787
-----------------------------------------------------
Fax | 443-869-6577
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5429 REISTERTOWN ROAD
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-869-6787
-----------------------------------------------------
Fax | 443-869-6577
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | EMMANUEL AKERORO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 443-869-6787
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | P06878
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------