Provider Demographics
NPI:1831446574
Name:COLLABORATE CARE PHARMACY & WELLNESS CENTER LLC
Entity type:Organization
Organization Name:COLLABORATE CARE PHARMACY & WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PHARMACIST / OPERATIONS MA
Authorized Official - Prefix:DR
Authorized Official - First Name:JANET
Authorized Official - Middle Name:EGBE
Authorized Official - Last Name:AYUK
Authorized Official - Suffix:
Authorized Official - Credentials:BSPHARM,PHARMD, RPH
Authorized Official - Phone:410-598-6486
Mailing Address - Street 1:3305 GARRISON BLVD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21216-1323
Mailing Address - Country:US
Mailing Address - Phone:410-367-3305
Mailing Address - Fax:410-367-3311
Practice Address - Street 1:3305 GARRISON BLVD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21216-1323
Practice Address - Country:US
Practice Address - Phone:410-367-3305
Practice Address - Fax:410-367-3311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-13
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13096261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health