Healthcare Provider Details

I. General information

NPI: 1700473667
Provider Name (Legal Business Name): ONYINYECHI MGBENKA PHARMD.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2020
Last Update Date: 12/28/2020
Certification Date: 12/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5405 LYNX LN
COLUMBIA MD
21044-2374
US

IV. Provider business mailing address

13105 PINE RD
BOWIE MD
20720-4745
US

V. Phone/Fax

Practice location:
  • Phone: 410-740-7273
  • Fax:
Mailing address:
  • Phone: 240-883-2292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26885
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: