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General NPI Number Information
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NPI Number | 1487927026
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Entity Type | Organization
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Legal Business Name | COMMUNITY CARE RX INC
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Dates
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Enumeration Date | 02/13/2012
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 11801 FINGERBOARD RD STE 6
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City | MONROVIA
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State | MD
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Zip | 21770-9030
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Country | US
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Telephone | 301-882-7370
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Fax | 301-882-7368
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Provider Business Mailing Address
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Address Line | 11801 FINGERBOARD RD SUITE 6
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City | MONROVIA
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State | MD
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Zip | 21770-9030
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Country | US
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Telephone | 301-882-7370
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Fax | 301-882-7368
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Authorized Official
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Title or Position | OWNER
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Name | MR. LEON JOHN MICAN JR.
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Credential |
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Telephone | 301-882-7370
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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 | PH05655
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License Number State | MD
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