Provider Demographics
NPI:1508454034
Name:MANFRED, OJONG OJONG
Entity Type:Individual
Prefix:
First Name:OJONG
Middle Name:OJONG
Last Name:MANFRED
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 1:3915 HOLLINS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21227-3416
Mailing Address - Country:US
Mailing Address - Phone:410-242-1441
Mailing Address - Fax:
Practice Address - Street 1:3915 HOLLINS FERRY RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21227-3416
Practice Address - Country:US
Practice Address - Phone:410-242-1441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-10
Last Update Date:2021-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27176183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist