Provider Demographics
NPI:1649587734
Name:OFUME, SUSAN O (PHARMACIST)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:O
Last Name:OFUME
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9367 KINGS GRANT RD
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-1396
Mailing Address - Country:US
Mailing Address - Phone:301-490-8221
Mailing Address - Fax:301-490-8221
Practice Address - Street 1:2043 MONDAWMIN MALL
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215
Practice Address - Country:US
Practice Address - Phone:410-523-6315
Practice Address - Fax:410-523-4796
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-10
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11946183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist