Healthcare Provider Details

I. General information

NPI: 1235950577
Provider Name (Legal Business Name): BLUE RIDGE HEALTH SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2024
Last Update Date: 10/19/2024
Certification Date: 10/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1053 MD RT 3 N STE 4
GAMBRILLS MD
21054-1781
US

IV. Provider business mailing address

2680 EVERGREEN RD
ODENTON MD
21113-2311
US

V. Phone/Fax

Practice location:
  • Phone: 240-354-5818
  • Fax:
Mailing address:
  • Phone: 240-354-5818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MRS. MORONKE A OBARO
Title or Position: OWNER
Credential: RPH
Phone: 240-354-5818