Provider Demographics
NPI:1497419279
Name:EZEH, EZEDI
Entity Type:Individual
Prefix:
First Name:EZEDI
Middle Name:
Last Name:EZEH
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 1:1801 WHETSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230-5199
Mailing Address - Country:US
Mailing Address - Phone:410-528-8484
Mailing Address - Fax:
Practice Address - Street 1:1801 WHETSTONE WAY
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230-5199
Practice Address - Country:US
Practice Address - Phone:410-528-8484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD28275183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist