MEDICARE: CHRISTIE AGWAMBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	27242	MD

General Provider Information

NPI Number	:	1265049803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTIE AGWAMBA

Provider Business Mailing Address
First Line	:	11219 SNOWDEN POND RD
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20708-3066
Country	:	US
Telephone Number	:	240-281-6913
Fax Number	:

Provider Business Practice Location Address
First Line	:	6104 OLD SILVER HILL RD
Second Line	:
City	:	DISTRICT HEIGHTS
State	:	MD
Zip	:	20747-2111
Country	:	US
Telephone Number	:	240-788-7357
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2020
Last Update Date	:	09/28/2020

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Directions to “ CHRISTIE AGWAMBA ” Practice Location

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