Healthcare Provider Details

I. General information

NPI: 1659136984
Provider Name (Legal Business Name): CHENIG LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2024
Last Update Date: 02/15/2024
Certification Date: 02/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12608 CAMBLETON DR
UPPER MARLBORO MD
20774-1730
US

IV. Provider business mailing address

12608 CAMBLETON DR
UPPER MARLBORO MD
20774-1730
US

V. Phone/Fax

Practice location:
  • Phone: 240-305-1970
  • Fax: 240-554-2457
Mailing address:
  • Phone: 240-305-1970
  • Fax: 240-554-2457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number
License Number State

VIII. Authorized Official

Name: MRS. NGOZI IKEJI
Title or Position: EXECUTIVE DIRECTOR
Credential: RPH
Phone: 240-305-1970