=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720188048
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOMECALL PHARMACEUTICAL SERVICES, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/25/2006
-----------------------------------------------------
Last Update Date | 06/02/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10200 OLD COLUMBIA RD SUITE M & N
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21046-2360
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-309-2500
-----------------------------------------------------
Fax | 410-309-2601
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10200 OLD COLUMBIA RD SUITE M & N
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21046-2360
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-309-2500
-----------------------------------------------------
Fax | 410-309-2601
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | MR. ROYCE BURRUSS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 410-309-2533
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251F00000X
-----------------------------------------------------
Taxonomy Name | Home Infusion Agency
-----------------------------------------------------
License Number | P01888
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------