MEDICARE: CHIBONY INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1245674746
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHIBONY INC.

Provider Business Mailing Address
First Line	:	13409 OAKLANDS MANOR DR
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20708-1423
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6500 WASHINGTON BLVD
Second Line	:	SUITE 103
City	:	ELKRIDGE
State	:	MD
Zip	:	21075-5571
Country	:	US
Telephone Number	:	410-796-1800
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANTHONY OBASI
Credential	:
Telephone Number	:	301-490-6316

Provider Enumeration Date	:	04/26/2013
Last Update Date	:	04/26/2013

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