Provider Demographics
NPI:1255429973
Name:NUTRICHOICE PARTNERS, INC
Entity type:Organization
Organization Name:NUTRICHOICE PARTNERS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:FLORENCE
Authorized Official - Last Name:ROWNAGHI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:301-495-1291
Mailing Address - Street 1:2313 DISTRIBUTION CIR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-1261
Mailing Address - Country:US
Mailing Address - Phone:301-495-1291
Mailing Address - Fax:
Practice Address - Street 1:2313 DISTRIBUTION CIR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-1261
Practice Address - Country:US
Practice Address - Phone:301-495-1291
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDPW0211332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDPW0211OtherPHARMACY LICENSE
MD430005000Medicaid
MD310500800Medicaid
MD430005000Medicaid