Organization
THERACOM
Active
Other names
TheraCom
Organization subpart
No
Provider details
NPI number
Authorized official
ALICIA EVANS RN (ASSISTANT SECRETARY)
(469) 365-7030
Entity
Organization
Contact information
Practice address
9717 KEY WEST AVE, ROCKVILLE, MD 20850-3982
(301) 337-4200
(301) 337-4135
Mailing address
9717 KEY WEST AVE, ROCKVILLE, MD 20850-3982
(301) 337-4200
(301) 337-4135
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336M0002X
Mail Order Pharmacy
—
—
3336S0011X
Specialty Pharmacy
Primary
PO5597
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2135654
PK
—
Enumeration date
11/08/2005
Last updated
04/17/2017
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