Provider Demographics
NPI:1497702203
Name:CHARLES CARE PHARMACY LLC
Entity Type:Organization
Organization Name:CHARLES CARE PHARMACY LLC
Other - Org Name:ANCHOR PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-848-9251
Mailing Address - Street 1:PO BOX 1750
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-0005
Mailing Address - Country:US
Mailing Address - Phone:410-848-9851
Mailing Address - Fax:443-639-0093
Practice Address - Street 1:11355 PEMBROOKE SQ
Practice Address - Street 2:STE 109
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-4805
Practice Address - Country:US
Practice Address - Phone:301-932-4200
Practice Address - Fax:301-870-7581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MDPO13273336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD405217000Medicaid
2127529OtherNCPDP PROVIDER IDENTIFICATION NUMBER
2127529OtherNCPDP PROVIDER IDENTIFICATION NUMBER