Healthcare Provider Details

I. General information

NPI: 1962380642
Provider Name (Legal Business Name): CHINENYE OGO ESORO RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2025
Last Update Date: 08/22/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3922 BLACKBURN LN
BURTONSVILLE MD
20866-1291
US

IV. Provider business mailing address

3922 BLACKBURN LN
BURTONSVILLE MD
20866-1291
US

V. Phone/Fax

Practice location:
  • Phone: 202-836-3506
  • Fax:
Mailing address:
  • Phone: 202-836-3506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number30449
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number30449
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code1835C0207X
TaxonomyCompounded Sterile Preparations Pharmacist
License Number30449
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: