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NPI Code Detail

MEDICARE: YOUR ASTHMA CARE PHARMACY, INC.

MEDICARE: YOUR ASTHMA CARE PHARMACY, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1333600000XPharmacyPW0404MD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PW0404OTHERMDMD BOARD OF PHARMACY

General Provider Information

NPI Number : 1073946349
Entity Type Code : Organization
Provider Name (Legal Business Name) : YOUR ASTHMA CARE PHARMACY, INC.
Provider Business Mailing Address
First Line : 5112 PEGASUS CT
Second Line : SUITE X-B
City : FREDERICK
State : MD
Zip : 21704-8303
Country : US
Telephone Number : 240-575-9097
Fax Number : 240-629-8769
Provider Business Practice Location Address
First Line : 5112 PEGASUS CT
Second Line : SUITE X-B
City : FREDERICK
State : MD
Zip : 21704-8303
Country : US
Telephone Number : 240-575-9097
Fax Number : 240-629-8769
Authorized Official
Title or Position : PRESIDENT / CEO
Name : MARILOU MARIE FRITZ
Credential : R.N.
Telephone Number : 240-575-9097
Provider Enumeration Date : 08/09/2013
Last Update Date : 10/26/2013

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