MEDICARE: CHARM CITY 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
1	333600000X	Pharmacy

General Provider Information

NPI Number	:	1972932069
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARM CITY PHARMACY INC

Provider Business Mailing Address
First Line	:	9476 FENS HOLW
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20723-5732
Country	:	US
Telephone Number	:	410-662-6000
Fax Number	:	410-662-6001

Provider Business Practice Location Address
First Line	:	2203 N CHARLES ST
Second Line	:	LOWER LEVEL
City	:	BALTIMORE
State	:	MD
Zip	:	21218-5740
Country	:	US
Telephone Number	:	410-662-6000
Fax Number	:	410-662-6001

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TEMITOPE O GBOLAGUN
Credential	:
Telephone Number	:	410-662-6000

Provider Enumeration Date	:	11/08/2013
Last Update Date	:	11/08/2013

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Directions to “CHARM CITY PHARMACY INC ” Practice Location

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