Provider Demographics
NPI:1003120932
Name:NDUKA, THEOPHILUS ANENE
Entity Type:Individual
Prefix:
First Name:THEOPHILUS
Middle Name:ANENE
Last Name:NDUKA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7153 SECURITY BLVD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21244-1811
Mailing Address - Country:US
Mailing Address - Phone:410-944-6400
Mailing Address - Fax:410-944-2492
Practice Address - Street 1:7153 SECURITY BLVD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21244-1811
Practice Address - Country:US
Practice Address - Phone:410-944-6400
Practice Address - Fax:410-944-2492
Is Sole Proprietor?:No
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10733183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist