MEDICARE: CHIMYKE CORP

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
1	333600000X	Pharmacy
2	3336C0004X	Compounding Pharmacy
3	332B00000X	Durable Medical Equipment & Medical Supplies
4	3336C0003X	Community/Retail Pharmacy	P02300	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2036501	OTHER		PK

General Provider Information

NPI Number	:	1679614523
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHIMYKE CORP

Provider Business Mailing Address
First Line	:	7676 NEW HAMPSHIRE AVE
Second Line	:	STE 104
City	:	TAKOMA PARK
State	:	MD
Zip	:	20912-7512
Country	:	US
Telephone Number	:	301-445-6050
Fax Number	:	301-445-6056

Provider Business Practice Location Address
First Line	:	7676 NEW HAMPSHIRE AVE
Second Line	:	STE 104
City	:	TAKOMA PARK
State	:	MD
Zip	:	20912-7512
Country	:	US
Telephone Number	:	301-445-6050
Fax Number	:	301-445-6056

Authorized Official
Title or Position	:	OWNER,RPH,AO
Name	:	MERYLN CRANDON
Credential	:	RPH
Telephone Number	:	301-445-6050

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	12/01/2015

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Directions to “CHIMYKE CORP ” Practice Location

Language	Start Address	Practice Location

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