Provider Demographics
NPI:1366488165
Name:NETCARE RX FREDERICK LLC
Entity Type:Organization
Organization Name:NETCARE RX FREDERICK LLC
Other - Org Name:TWIN KNOLLS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AREA MGR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:DIPAULA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH BS MBA
Authorized Official - Phone:443-276-1020
Mailing Address - Street 1:110 BAUGHMANS LN
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4011
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:110 BAUGHMANS LN
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4011
Practice Address - Country:US
Practice Address - Phone:301-698-1411
Practice Address - Fax:301-631-8275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP01898333600000X
3336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered333600000XSuppliersPharmacy
Not Answered3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2124939OtherOTHER ID NUMBER-COMMERCIAL NUMBER