Provider Demographics
NPI:1407353030
Name:UDORO, MAILAKA (PHARMD, MBA, BCGP)
Entity Type:Individual
Prefix:MRS
First Name:MAILAKA
Middle Name:
Last Name:UDORO
Suffix:
Gender:F
Credentials:PHARMD, MBA, BCGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7818 SHADOW KNOLL CT
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-3410
Mailing Address - Country:US
Mailing Address - Phone:443-425-2210
Mailing Address - Fax:
Practice Address - Street 1:7818 SHADOW KNOLL CT
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-3410
Practice Address - Country:US
Practice Address - Phone:443-425-2210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-10
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15347183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist