Healthcare Provider Details

I. General information

NPI: 1245743293
Provider Name (Legal Business Name): OBIANUJU OKORONKWO RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2017
Last Update Date: 11/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7535 HOLABIRD AVE
BALTIMORE MD
21222-2105
US

IV. Provider business mailing address

7535 HOLABIRD AVE
BALTIMORE MD
21222-2105
US

V. Phone/Fax

Practice location:
  • Phone: 410-282-4020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number25411
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: