=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982118089
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRIDGET ALIA NGWA PHARMACIST
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/28/2017
-----------------------------------------------------
Last Update Date | 11/28/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1510 REISTERSTOWN RD
-----------------------------------------------------
City | PIKESVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21208-3814
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-484-0196
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2 ATHENRY CT APT 101
-----------------------------------------------------
City | LUTHERVILLE TIMONIUM
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21093-7974
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-682-8374
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1835P0018X
-----------------------------------------------------
Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
-----------------------------------------------------
License Number | 24965
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------