Healthcare Provider Details

I. General information

NPI: 1831001379
Provider Name (Legal Business Name): NANA ESI KOMEH BRAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1117 FUTURITY ST
FREDERICK MD
21702-2358
US

IV. Provider business mailing address

1117 FUTURITY ST
FREDERICK MD
21702-2358
US

V. Phone/Fax

Practice location:
  • Phone: 301-682-1644
  • Fax:
Mailing address:
  • Phone: 301-682-1644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP406635
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: