Provider Demographics
NPI:1760896997
Name:AYUKETAH, ADOLF SCHWARTZ MBI
Entity Type:Individual
Prefix:
First Name:ADOLF SCHWARTZ
Middle Name:MBI
Last Name:AYUKETAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8201 ANNAPOLIS RD
Mailing Address - Street 2:
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-3016
Mailing Address - Country:US
Mailing Address - Phone:301-577-6222
Mailing Address - Fax:301-459-1826
Practice Address - Street 1:8201 ANNAPOLIS RD
Practice Address - Street 2:
Practice Address - City:NEW CARROLLTON
Practice Address - State:MD
Practice Address - Zip Code:20784-3016
Practice Address - Country:US
Practice Address - Phone:301-577-6222
Practice Address - Fax:301-459-1826
Is Sole Proprietor?:No
Enumeration Date:2014-06-16
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18665183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist