Healthcare Provider Details

I. General information

NPI: 1992525349
Provider Name (Legal Business Name): EMMANUEL OGBONNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2024
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5740 RITCHIE HWY
BROOKLYN MD
21225-3641
US

IV. Provider business mailing address

5740 RITCHIE HWY
BROOKLYN MD
21225-3641
US

V. Phone/Fax

Practice location:
  • Phone: 410-789-2127
  • Fax: 410-789-1827
Mailing address:
  • Phone: 410-789-2127
  • Fax: 410-789-1827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number30082
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: