Provider Demographics
NPI:1245787126
Name:OPPONG, MYLOVE
Entity Type:Individual
Prefix:
First Name:MYLOVE
Middle Name:
Last Name:OPPONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5405 LYNX LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-2374
Mailing Address - Country:US
Mailing Address - Phone:410-740-7273
Mailing Address - Fax:
Practice Address - Street 1:5405 LYNX LN
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2374
Practice Address - Country:US
Practice Address - Phone:410-740-7273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24414183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist