MEDICARE: OBIESIEMIKE IJEABUONWU

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	183500000X	Pharmacist	PHA3260	DC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PHA3260	OTHER	DC	PHARMACIST

General Provider Information

NPI Number	:	1891134516
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OBIESIEMIKE IJEABUONWU

Provider Business Mailing Address
First Line	:	9307 HOBART ST
Second Line	:
City	:	SPRINGDALE
State	:	MD
Zip	:	20774-5413
Country	:	US
Telephone Number	:	202-450-3655
Fax Number	:

Provider Business Practice Location Address
First Line	:	1219 BRENTWOOD RD NE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20018-1019
Country	:	US
Telephone Number	:	202-450-3655
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2013
Last Update Date	:	06/15/2013

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