Provider Demographics
NPI:1619987534
Name:IHEAGWARA, NNENNA LILLIAN (PHARMD, BCPS)
Entity Type:Individual
Prefix:DR
First Name:NNENNA
Middle Name:LILLIAN
Last Name:IHEAGWARA
Suffix:
Gender:F
Credentials:PHARMD, BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7520 HELSTON CT
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-1923
Mailing Address - Country:US
Mailing Address - Phone:215-620-5306
Mailing Address - Fax:
Practice Address - Street 1:10 N GREENE ST # 119
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1524
Practice Address - Country:US
Practice Address - Phone:410-605-7000
Practice Address - Fax:410-605-7852
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD172911835P1200X
PARP4394881835P1200X
DEA1-00035071835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy