Healthcare Provider Details

I. General information

NPI: 1184532889
Provider Name (Legal Business Name): NNENNA IHUOMA ONYIMA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 WATKINS PARK DR
UPPER MARLBORO MD
20774-1628
US

IV. Provider business mailing address

28 WATKINS PARK DR
UPPER MARLBORO MD
20774-1628
US

V. Phone/Fax

Practice location:
  • Phone: 301-249-4664
  • Fax:
Mailing address:
  • Phone: 301-249-4664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number31110
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: