Healthcare Provider Details

I. General information

NPI: 1740424688
Provider Name (Legal Business Name): MERCY O NNANNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2009
Last Update Date: 04/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2915 EMERALD RD
BALTIMORE MD
21234-5636
US

IV. Provider business mailing address

2915 EMERALD RD
BALTIMORE MD
21234-5636
US

V. Phone/Fax

Practice location:
  • Phone: 410-882-4982
  • Fax:
Mailing address:
  • Phone: 410-882-4982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number12376
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: