Healthcare Provider Details

I. General information

NPI: 1952902215
Provider Name (Legal Business Name): ALICE ADA OHANELE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2020
Last Update Date: 11/07/2020
Certification Date: 11/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 ANNAPOLIS RD
ODENTON MD
21113-1602
US

IV. Provider business mailing address

3720 GREEN ASH CT
BELTSVILLE MD
20705-3826
US

V. Phone/Fax

Practice location:
  • Phone: 410-674-8338
  • Fax:
Mailing address:
  • Phone: 240-472-9221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number27625
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: