Provider Demographics
NPI:1972916682
Name:FOKOS GROUP LLC
Entity type:Organization
Organization Name:FOKOS GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FUNMILAYO
Authorized Official - Middle Name:
Authorized Official - Last Name:FADINA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:443-904-3009
Mailing Address - Street 1:6020 MEADOWRIDGE CENTER DR
Mailing Address - Street 2:STE B
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-6528
Mailing Address - Country:US
Mailing Address - Phone:410-799-7227
Mailing Address - Fax:
Practice Address - Street 1:6020 MEADOWRIDGE CENTER DR
Practice Address - Street 2:STE B
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-6528
Practice Address - Country:US
Practice Address - Phone:410-799-7227
Practice Address - Fax:410-799-2660
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FOKOS GROUP LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-06-10
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP06385333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD479903800Medicaid
MD479903800Medicaid