Provider Demographics
NPI:1972549483
Name:CHARLES CARE PHARMACIES LLC
Entity type:Organization
Organization Name:CHARLES CARE PHARMACIES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-848-9251
Mailing Address - Street 1:PO BOX 1723
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21158-5723
Mailing Address - Country:US
Mailing Address - Phone:410-848-9251
Mailing Address - Fax:443-639-0093
Practice Address - Street 1:504 EAST CHARLES ST
Practice Address - Street 2:
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-5931
Practice Address - Country:US
Practice Address - Phone:301-934-0648
Practice Address - Fax:301-609-7816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP04344333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD005491700Medicaid
2132467OtherOTHER ID NUMBER-COMMERCIAL NUMBER
MD5159850002Medicare NSC