Healthcare Provider Details

I. General information

NPI: 1942893052
Provider Name (Legal Business Name): MABINTOU EADES PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BINTOU EADES PHARMD

II. Dates (important events)

Enumeration Date: 02/19/2021
Last Update Date: 02/19/2021
Certification Date: 02/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 MORSE RD
COLUMBUS OH
43219-3016
US

IV. Provider business mailing address

778 TRICOLOR DR
REYNOLDSBURG OH
43068-4752
US

V. Phone/Fax

Practice location:
  • Phone: 479-877-5412
  • Fax:
Mailing address:
  • Phone: 479-877-5412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202208241
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03438542
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: