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General NPI Number Information
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NPI Number | 1831446574
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Entity Type | Organization
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Legal Business Name | COLLABORATE CARE PHARMACY & WELLNESS CENTER LLC
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Dates
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Enumeration Date | 08/13/2012
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Last Update Date | 02/06/2013
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Provider Practice Location Address
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Address Line | 3305 GARRISON BLVD
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City | BALTIMORE
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State | MD
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Zip | 21216-1323
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Country | US
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Telephone | 410-367-3305
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Fax | 410-367-3311
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Provider Business Mailing Address
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Address Line | 3305 GARRISON BLVD
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City | BALTIMORE
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State | MD
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Zip | 21216-1323
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Country | US
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Telephone | 410-367-3305
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Fax | 410-367-3311
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Authorized Official
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Title or Position | CLINICAL PHARMACIST / OPERATIONS MA
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Name | DR. JANET EGBE AYUK
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Credential | BSPHARM,PHARMD, RPH
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Telephone | 410-598-6486
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number | 13096
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License Number State | MD
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