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General NPI Number Information
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NPI Number | 1063292399
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Entity Type | Organization
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Legal Business Name | OBRA PHARMACY
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Dates
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Enumeration Date | 10/04/2023
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Last Update Date | 10/04/2023
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Provider Practice Location Address
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Address Line | 15525 NEW HAMPSHIRE AVE
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City | SILVER SPRING
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State | MD
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Zip | 20905-4077
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Country | US
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Telephone | 301-847-9507
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Fax |
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Provider Business Mailing Address
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Address Line | 7009 VAN DUSEN RD
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City | LAUREL
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State | MD
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Zip | 20707-5256
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MYLOVE O OPPONG
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Credential |
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Telephone | 410-740-7273
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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