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General NPI Number Information
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NPI Number | 1700067618
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Entity Type | Organization
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Legal Business Name | FRIENDLY PHARMACY LLC
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Dates
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Enumeration Date | 11/19/2007
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Last Update Date | 12/19/2007
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Provider Practice Location Address
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Address Line | 226 TOWN CENTER DR
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City | LUSBY
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State | MD
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Zip | 20657
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Country | US
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Telephone | 410-326-2260
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Fax | 410-326-3360
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Provider Business Mailing Address
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Address Line | 226 TOWN CENTER DR
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City | LUSBY
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State | MD
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Zip | 20657
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | VINCENT JACKSON
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Credential |
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Telephone | 301-580-3818
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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 | P04671
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License Number State | MD
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