Healthcare Provider Details

I. General information

NPI: 1881297216
Provider Name (Legal Business Name): STEVEN MBAGWU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2020
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11085 CATHELL RD
BERLIN MD
21811-9301
US

IV. Provider business mailing address

420 E NORTH POINTE DR APT 256
SALISBURY MD
21804-2350
US

V. Phone/Fax

Practice location:
  • Phone: 248-299-0030
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number30902
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: