Provider Demographics
NPI:1497055990
Name:EBONINE, CHINEDU IHEANACHO (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CHINEDU
Middle Name:IHEANACHO
Last Name:EBONINE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1451 RITCHIE HWY
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MD
Mailing Address - Zip Code:21012-2557
Mailing Address - Country:US
Mailing Address - Phone:410-757-7792
Mailing Address - Fax:410-757-0242
Practice Address - Street 1:1451 RITCHIE HWY
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MD
Practice Address - Zip Code:21012-2557
Practice Address - Country:US
Practice Address - Phone:410-757-7792
Practice Address - Fax:410-757-0242
Is Sole Proprietor?:No
Enumeration Date:2010-10-30
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19307183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist