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General NPI Number Information
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NPI Number | 1669541777
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Entity Type | Organization
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Legal Business Name | PRIME, INC
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 02/14/2008
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Provider Practice Location Address
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Address Line | 1647 BENNING RD NE STE 101
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City | WASHINGTON
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State | DC
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Zip | 20002-4569
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Country | US
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Telephone | 202-399-7876
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Fax | 202-388-3157
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Provider Business Mailing Address
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Address Line | 1647 BENNING RD NE STE 101
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City | WASHINGTON
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State | DC
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Zip | 20002-4569
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Country | US
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Telephone | 202-399-7876
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Fax | 202-388-3157
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | MR. OMOLOLU ABIMBOLA FATUKASI
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Credential | R. PH
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Telephone | 202-399-7876
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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 | RX0200323
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License Number State | DC
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