Provider Demographics
NPI:1508877093
Name:GOOD CARE PHARMACY INC
Entity Type:Organization
Organization Name:GOOD CARE PHARMACY INC
Other - Org Name:GOOD CARE PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEGHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-561-4343
Mailing Address - Street 1:2910 MARTIN LUTHER KING JR AVE SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-2522
Mailing Address - Country:US
Mailing Address - Phone:202-561-4343
Mailing Address - Fax:202-561-5061
Practice Address - Street 1:2910 MARTIN LUTHER KING JR AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-2522
Practice Address - Country:US
Practice Address - Phone:202-561-4343
Practice Address - Fax:202-561-5061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
DCRX12000053336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2005928OtherPK
DC036860100Medicaid
5498450001Medicare NSC