Provider Demographics
NPI:1508804972
Name:GLEN ECHO CARE PHARMACY
Entity Type:Organization
Organization Name:GLEN ECHO CARE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:SINKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-229-5656
Mailing Address - Street 1:7311 MACARTHUR BLVD
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20816-1036
Mailing Address - Country:US
Mailing Address - Phone:301-229-5656
Mailing Address - Fax:301-229-3036
Practice Address - Street 1:7311 MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20816-1036
Practice Address - Country:US
Practice Address - Phone:301-229-5656
Practice Address - Fax:301-229-3036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2010-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05380183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD402597100Medicaid
MA2108327OtherOLD NCPDP
MA2108327OtherOLD NCPDP