Provider Demographics
NPI:1487192829
Name:FORT WASHINGTON PHARMACY,LLC
Entity Type:Organization
Organization Name:FORT WASHINGTON PHARMACY,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAWFIK
Authorized Official - Middle Name:
Authorized Official - Last Name:BESHIR
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:301-747-4760
Mailing Address - Street 1:12764 OLD FORT RD
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-2871
Mailing Address - Country:US
Mailing Address - Phone:301-747-4760
Mailing Address - Fax:
Practice Address - Street 1:12764 OLD FORT RD
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-2871
Practice Address - Country:US
Practice Address - Phone:301-747-4760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-06
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy