Healthcare Provider Details

I. General information

NPI: 1003064866
Provider Name (Legal Business Name): PROTUS UKEOMAH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2008
Last Update Date: 09/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 HICKORY RD SUITE 240
PLYMOUTH MEETING PA
19462-1047
US

IV. Provider business mailing address

13721 PINE NEEDLE CT
UPPER MARLBORO MD
20774-4218
US

V. Phone/Fax

Practice location:
  • Phone: 610-834-1122
  • Fax:
Mailing address:
  • Phone: 202-701-5848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHA3147
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13936
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: