Healthcare Provider Details

I. General information

NPI: 1073031555
Provider Name (Legal Business Name): LOTIKA AMAKA UGBOME PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2017
Last Update Date: 09/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3110 OLNEY SANDY SPRING RD
OLNEY MD
20832-1408
US

IV. Provider business mailing address

1101 HIGGINS PL APT 201
ROCKVILLE MD
20852-6726
US

V. Phone/Fax

Practice location:
  • Phone: 301-774-6155
  • Fax:
Mailing address:
  • Phone: 240-605-1773
  • Fax: 240-605-1773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number25250
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: