Provider Demographics
NPI:1700140142
Name:CARDOZO PHARMACY LLC
Entity Type:Organization
Organization Name:CARDOZO PHARMACY LLC
Other - Org Name:CARDOZO PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-316-7293
Mailing Address - Street 1:2701 14TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-6994
Mailing Address - Country:US
Mailing Address - Phone:202-986-4590
Mailing Address - Fax:202-986-4595
Practice Address - Street 1:2701 14TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-6994
Practice Address - Country:US
Practice Address - Phone:202-986-4590
Practice Address - Fax:202-986-4595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-29
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
DCRX11004353336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC069740500Medicaid
0904878OtherNCPDP PROVIDER IDENTIFICATION NUMBER