Provider Demographics
NPI:1073946349
Name:YOUR ASTHMA CARE PHARMACY, INC.
Entity type:Organization
Organization Name:YOUR ASTHMA CARE PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARILOU
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:FRITZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:240-575-9097
Mailing Address - Street 1:5112 PEGASUS CT
Mailing Address - Street 2:SUITE X-B
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21704-8303
Mailing Address - Country:US
Mailing Address - Phone:240-575-9097
Mailing Address - Fax:240-629-8769
Practice Address - Street 1:5112 PEGASUS CT
Practice Address - Street 2:SUITE X-B
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21704-8303
Practice Address - Country:US
Practice Address - Phone:240-575-9097
Practice Address - Fax:240-629-8769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-09
Last Update Date:2013-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDPW0404333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDPW0404OtherMD BOARD OF PHARMACY