Provider Demographics
NPI:1326228529
Name:ANYIWO, BRIDGET RALUCHUKWU
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:RALUCHUKWU
Last Name:ANYIWO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:
Other - Last Name:ANYIWO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:14305 DUNWOOD VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-1251
Mailing Address - Country:US
Mailing Address - Phone:301-218-0019
Mailing Address - Fax:
Practice Address - Street 1:1221 MERCANTILE LN
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5374
Practice Address - Country:US
Practice Address - Phone:301-618-5856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-06
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14767183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist