Provider Demographics
NPI:1003851205
Name:HERCOL INC
Entity Type:Organization
Organization Name:HERCOL INC
Other - Org Name:SERVICE CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:AYU
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:301-495-7775
Mailing Address - Street 1:1111 SPRING ST
Mailing Address - Street 2:STE 110
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-4003
Mailing Address - Country:US
Mailing Address - Phone:301-495-7775
Mailing Address - Fax:301-495-7760
Practice Address - Street 1:1111 SPRING ST
Practice Address - Street 2:STE 110
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4003
Practice Address - Country:US
Practice Address - Phone:301-495-7775
Practice Address - Fax:301-495-7760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP043633336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD414841000Medicaid
2132847OtherNCPDP PROVIDER IDENTIFICATION NUMBER
2132847OtherNCPDP PROVIDER IDENTIFICATION NUMBER