Provider Demographics
NPI:1730245002
Name:BOWIE COMCARE PHARMACY LLC
Entity type:Organization
Organization Name:BOWIE COMCARE PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER,PIC
Authorized Official - Prefix:
Authorized Official - First Name:MARIE THERESE
Authorized Official - Middle Name:
Authorized Official - Last Name:OYALOWO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:301-262-2877
Mailing Address - Street 1:15431 EXCELSIOR DR
Mailing Address - Street 2:BOWIE TOWN CENTER
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-2208
Mailing Address - Country:US
Mailing Address - Phone:301-262-2877
Mailing Address - Fax:301-262-4488
Practice Address - Street 1:15431 EXCELSIOR DR
Practice Address - Street 2:BOWIE TOWN CENTER
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-2208
Practice Address - Country:US
Practice Address - Phone:301-262-2877
Practice Address - Fax:301-262-4488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0004X, 333600000X
MDP026613336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD401839700Medicaid
2037372OtherPK
MD699745700Medicaid
MD699745700Medicaid