Healthcare Provider Details

I. General information

NPI: 1992425631
Provider Name (Legal Business Name): EVELYN OWUSU PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2022
Last Update Date: 09/01/2022
Certification Date: 09/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 LAKESIDE BLVD
OWINGS MILLS MD
21117-4953
US

IV. Provider business mailing address

6619 ENGLISH OAK RD APT I
PARKVILLE MD
21234-6779
US

V. Phone/Fax

Practice location:
  • Phone: 410-363-8066
  • Fax: 410-363-2647
Mailing address:
  • Phone: 443-635-8944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28771
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: