Healthcare Provider Details

I. General information

NPI: 1063292399
Provider Name (Legal Business Name): OBRA PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2023
Last Update Date: 10/04/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15525 NEW HAMPSHIRE AVE
SILVER SPRING MD
20905-4077
US

IV. Provider business mailing address

7009 VAN DUSEN RD
LAUREL MD
20707-5256
US

V. Phone/Fax

Practice location:
  • Phone: 301-847-9507
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MYLOVE O OPPONG
Title or Position: OWNER
Credential:
Phone: 410-740-7273