Provider Demographics
NPI:1437494416
Name:FORT LINCOLN PHARMACY & MEDICAL EQUIPMENT, LLC
Entity Type:Organization
Organization Name:FORT LINCOLN PHARMACY & MEDICAL EQUIPMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ENOCK
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEWUYI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-269-0000
Mailing Address - Street 1:3180 BLADENSBURG RD. N.E.
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20018
Mailing Address - Country:US
Mailing Address - Phone:202-269-0000
Mailing Address - Fax:202-269-0100
Practice Address - Street 1:3180 BLADENSBURG RD. N.E.
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018
Practice Address - Country:US
Practice Address - Phone:202-269-0000
Practice Address - Fax:202-269-0100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-03
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRX12000233336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy