Healthcare Provider Details

I. General information

NPI: 1952707317
Provider Name (Legal Business Name): IFEOMA ILE OBIOHA-OFFODILE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2014
Last Update Date: 11/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3240 BELAIR RD
BALTIMORE MD
21213-1228
US

IV. Provider business mailing address

3533 CASTLE WAY
SILVER SPRING MD
20904-4718
US

V. Phone/Fax

Practice location:
  • Phone: 410-342-0616
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHA24115
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number12346
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: