Provider Demographics
NPI:1982156246
Name:DIVINE CARE PHARMACY
Entity Type:Organization
Organization Name:DIVINE CARE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OKWUCHI
Authorized Official - Middle Name:
Authorized Official - Last Name:OBASI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:240-678-2804
Mailing Address - Street 1:1631 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21217-1737
Mailing Address - Country:US
Mailing Address - Phone:443-873-8294
Mailing Address - Fax:443-873-8413
Practice Address - Street 1:1631 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21217-1737
Practice Address - Country:US
Practice Address - Phone:443-873-8294
Practice Address - Fax:443-873-8413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-02
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP07231183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty