Provider Demographics
NPI:1063788230
Name:WELCARE PHARMACY LLC
Entity type:Organization
Organization Name:WELCARE PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:CHAITANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHITTIMALLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-245-4196
Mailing Address - Street 1:300 E PULASKI HWY STE 103
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-6737
Mailing Address - Country:US
Mailing Address - Phone:443-207-5105
Mailing Address - Fax:443-207-8214
Practice Address - Street 1:300 E PULASKI HWY STE 103
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-6737
Practice Address - Country:US
Practice Address - Phone:443-207-5105
Practice Address - Fax:443-207-8214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-01
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP056753336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2135399OtherPK