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General NPI Number Information
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NPI Number | 1255679585
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Entity Type | Individual
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Provider Name | ISRAEL C AGWAMBA RPH
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Gender | Male
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Dates
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Enumeration Date | 01/22/2013
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Last Update Date | 01/22/2013
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Provider Practice Location Address
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Address Line | 3180 BLADENSBURG RD
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City | WASHINGTON
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State | DC
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Zip | 20018
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Country | US
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Telephone | 202-269-0000
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Fax | 202-269-0100
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Provider Business Mailing Address
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Address Line | 11219 SNOWDEN POND RD
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City | LAUREL
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State | MD
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Zip | 20708-3066
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Country | US
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Telephone | 301-254-4900
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PH3254
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 13868
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License Number State | MD
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