Provider Demographics
NPI:1659315851
Name:FAMILY CARE PHARMACY, INC.
Entity Type:Organization
Organization Name:FAMILY CARE PHARMACY, INC.
Other - Org Name:JESSUP CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BURCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-332-3845
Mailing Address - Street 1:8610 BALTIMORE WASHINGTON BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:JESSUP
Mailing Address - State:MD
Mailing Address - Zip Code:20794
Mailing Address - Country:US
Mailing Address - Phone:301-483-0795
Mailing Address - Fax:301-483-0797
Practice Address - Street 1:8610 BALTIMORE WASHINGTON BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:JESSUP
Practice Address - State:MD
Practice Address - Zip Code:20794
Practice Address - Country:US
Practice Address - Phone:301-483-0795
Practice Address - Fax:301-483-0797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
MDP073123336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD079500300Medicaid
2137074OtherPK
2137074OtherPK