Healthcare Provider Details

I. General information

NPI: 1891386959
Provider Name (Legal Business Name): UCHEUMA OBUA PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2021
Last Update Date: 02/01/2021
Certification Date: 02/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 GARRETT AVE
LA PLATA MD
20646-5960
US

IV. Provider business mailing address

1016 PALMER RD APT 8
FORT WASHINGTON MD
20744-4686
US

V. Phone/Fax

Practice location:
  • Phone: 443-865-1511
  • Fax:
Mailing address:
  • Phone: 443-865-1511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH233825
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number22086
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: