Provider Demographics
NPI:1740581362
Name:1ST PHARMANEX
Entity Type:Organization
Organization Name:1ST PHARMANEX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ERONMWON
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:OKONJO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:202-706-0780
Mailing Address - Street 1:4715 RIVER VALLEY WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-3432
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4715 RIVER VALLEY WAY STE 100
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20720-3432
Practice Address - Country:US
Practice Address - Phone:202-706-0780
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-12
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR2803332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies