Provider Demographics
NPI:1417560962
Name:CROWNS PHARMACY LLC
Entity type:Organization
Organization Name:CROWNS PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHUKWUEDOZIE
Authorized Official - Middle Name:H
Authorized Official - Last Name:OKOTCHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-477-7141
Mailing Address - Street 1:6381 GRATEFUL HEART GATE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-6003
Mailing Address - Country:US
Mailing Address - Phone:301-477-7141
Mailing Address - Fax:240-391-6676
Practice Address - Street 1:9705 FORT MEADE RD
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-4405
Practice Address - Country:US
Practice Address - Phone:301-477-7141
Practice Address - Fax:240-391-6676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD424843100Medicaid