Provider Demographics
NPI:1245608397
Name:OBOH, OKECHUKWU CASMIR
Entity Type:Individual
Prefix:
First Name:OKECHUKWU
Middle Name:CASMIR
Last Name:OBOH
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 1:425 DENNIS MAGRUDER DR
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-2104
Mailing Address - Country:US
Mailing Address - Phone:301-808-0599
Mailing Address - Fax:
Practice Address - Street 1:425 DENNIS MAGRUDER DR
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-2104
Practice Address - Country:US
Practice Address - Phone:301-808-0599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-07
Last Update Date:2015-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23408183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist