Provider Demographics
NPI:1427558527
Name:FRONTIER HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:FRONTIER HEALTH SERVICES LLC
Other - Org Name:CAREMAX PHARMACY 2
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARM.D
Authorized Official - Prefix:
Authorized Official - First Name:UCHE
Authorized Official - Middle Name:
Authorized Official - Last Name:ETUNNUH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-251-2718
Mailing Address - Street 1:1251 W PRATT ST STE D
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21223-2665
Mailing Address - Country:US
Mailing Address - Phone:667-930-3175
Mailing Address - Fax:667-930-3982
Practice Address - Street 1:1251 W PRATT ST STE D
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21223-2665
Practice Address - Country:US
Practice Address - Phone:667-930-3175
Practice Address - Fax:667-930-3982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-15
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MDP077053336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2175836OtherPK