Healthcare Provider Details

I. General information

NPI: 1023315033
Provider Name (Legal Business Name): MOA BIFTU PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2011
Last Update Date: 02/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11401 COASTAL HWY
OCEAN CITY MD
21842-7537
US

IV. Provider business mailing address

3 OCALA CT
FREEHOLD NJ
07728-8645
US

V. Phone/Fax

Practice location:
  • Phone: 410-524-3700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number19351
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: