Provider Demographics
NPI:1730460122
Name:IKEJI, NGOZI BERNADETTE
Entity Type:Individual
Prefix:MRS
First Name:NGOZI
Middle Name:BERNADETTE
Last Name:IKEJI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12608 CAMBLETON DR
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-1730
Mailing Address - Country:US
Mailing Address - Phone:240-305-1970
Mailing Address - Fax:
Practice Address - Street 1:12608 CAMBLETON DR
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-1730
Practice Address - Country:US
Practice Address - Phone:240-305-1970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16159183500000X
VAPH1000007791835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist