Healthcare Provider Details

I. General information

NPI: 1326693391
Provider Name (Legal Business Name): IFEANYI ISRAEL OGBONNA RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2019
Last Update Date: 08/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 E WILSON BLVD
HAGERSTOWN MD
21740-7331
US

IV. Provider business mailing address

3016 HICKORY WOODS DR NE APT 132
ROANOKE VA
24012-6359
US

V. Phone/Fax

Practice location:
  • Phone: 301-790-0710
  • Fax:
Mailing address:
  • Phone: 513-823-5270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26291
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: