=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346476348
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHINYELU ONWUMBIKO PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/04/2009
-----------------------------------------------------
Last Update Date | 06/04/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 316 TALBOTT AVE SUITE B
-----------------------------------------------------
City | LAUREL
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-554-0310
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15912 WILLIS WAY
-----------------------------------------------------
City | WOODBINE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21797-7518
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-489-9111
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 15338
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1835P0018X
-----------------------------------------------------
Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
-----------------------------------------------------
License Number | 15338
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------