Provider Demographics
NPI:1750821302
Name:AZU, PRISCILLA DEDE
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:DEDE
Last Name:AZU
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 1:11325 COLUMBIA PIKE APT C1
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-2503
Mailing Address - Country:US
Mailing Address - Phone:774-670-6974
Mailing Address - Fax:
Practice Address - Street 1:355 MARKET SQUARE DR
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-3173
Practice Address - Country:US
Practice Address - Phone:410-535-5313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-01
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD246931835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy