Provider Demographics
NPI:1447398433
Name:AMBULATORY CARE PHARMACY INC
Entity Type:Organization
Organization Name:AMBULATORY CARE PHARMACY INC
Other - Org Name:AMBULATORY CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:NUSBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-424-1411
Mailing Address - Street 1:9715 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3320
Mailing Address - Country:US
Mailing Address - Phone:301-424-1411
Mailing Address - Fax:301-424-0232
Practice Address - Street 1:9715 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3320
Practice Address - Country:US
Practice Address - Phone:301-424-1411
Practice Address - Fax:301-424-0232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MDP013113336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD554542100Medicaid
2111653OtherNCPDP PROVIDER IDENTIFICATION NUMBER