Healthcare Provider Details

I. General information

NPI: 1801322797
Provider Name (Legal Business Name): UWAOMA ONYEBUENYI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: UWAOMA ONYEBUENYI PHARMACIST

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 05/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 ALTA VISTA DR
BOWIE MD
20721-4053
US

IV. Provider business mailing address

3701 ALTA VISTA DR
BOWIE MD
20721-4053
US

V. Phone/Fax

Practice location:
  • Phone: 240-460-0390
  • Fax:
Mailing address:
  • Phone: 240-460-0390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberDH100002224
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number24053
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: