Healthcare Provider Details

I. General information

NPI: 1659560894
Provider Name (Legal Business Name): NKEMDIRIM OHAMUO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2007
Last Update Date: 09/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 LIBERTY HEIGHTS AVE
BALTIMORE MD
21215-7118
US

IV. Provider business mailing address

9958 LINDEN HILL RD
OWINGS MILLS MD
21117-6152
US

V. Phone/Fax

Practice location:
  • Phone: 410-367-8100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number18180
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: