Healthcare Provider Details

I. General information

NPI: 1316350945
Provider Name (Legal Business Name): MICHAEL UCHE OBASI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2014
Last Update Date: 06/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1712 CRAIN HWY S
GLEN BURNIE MD
21061-5503
US

IV. Provider business mailing address

1712 CRAIN HWY S
GLEN BURNIE MD
21061-5503
US

V. Phone/Fax

Practice location:
  • Phone: 410-761-1099
  • Fax:
Mailing address:
  • Phone: 410-761-1099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number17397
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: