Provider Demographics
NPI:1821875170
Name:MEDACCESS PHARMACY SVC LLC
Entity Type:Organization
Organization Name:MEDACCESS PHARMACY SVC LLC
Other - Org Name:LAUREL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:EJIKE
Authorized Official - Middle Name:IZUNDU
Authorized Official - Last Name:UNEGBU
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:301-604-8500
Mailing Address - Street 1:7350 VAN DUSEN RD STE 120
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-5267
Mailing Address - Country:US
Mailing Address - Phone:301-604-8500
Mailing Address - Fax:301-604-8887
Practice Address - Street 1:7350 VAN DUSEN RD STE 120
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5267
Practice Address - Country:US
Practice Address - Phone:301-604-8500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistGroup - Multi-Specialty