=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508200163
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHARMVUE CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/24/2013
-----------------------------------------------------
Last Update Date | 02/13/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3460 OLD WASHINGTON RD SUITE 103
-----------------------------------------------------
City | WALDORF
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20602-3240
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-645-2400
-----------------------------------------------------
Fax | 301-476-0382
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1282 SMALLWOOD DR W SUITE 284
-----------------------------------------------------
City | WALDORF
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20603-4732
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-645-2400
-----------------------------------------------------
Fax | 301-476-0382
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | MRS. NAJWA BROWN
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 301-645-2400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | P05973
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------