=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982665345
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEDCARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14900 SWEITZER LN SUITE 103
-----------------------------------------------------
City | LAUREL
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20707-2915
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-497-6171
-----------------------------------------------------
Fax | 301-497-6191
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14900 SWEITZER LN SUITE 103
-----------------------------------------------------
City | LAUREL
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20707-2915
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-497-6171
-----------------------------------------------------
Fax | 301-497-6191
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | GENERAL MANAGER
-----------------------------------------------------
Name | MR. FARIBORZ ZARFESHAN
-----------------------------------------------------
Credential | R.PH.
-----------------------------------------------------
Telephone | 30149756171
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | PW0224
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------