Provider Demographics
NPI:1972932069
Name:CHARM CITY PHARMACY INC
Entity Type:Organization
Organization Name:CHARM CITY PHARMACY INC
Other - Org Name:WELLCARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TEMITOPE
Authorized Official - Middle Name:O
Authorized Official - Last Name:GBOLAGUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-662-6000
Mailing Address - Street 1:9476 FENS HOLW
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-5732
Mailing Address - Country:US
Mailing Address - Phone:410-662-6000
Mailing Address - Fax:410-662-6001
Practice Address - Street 1:2203 N CHARLES ST
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-5740
Practice Address - Country:US
Practice Address - Phone:410-662-6000
Practice Address - Fax:410-662-6001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-08
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy