Provider Demographics
NPI:1770183402
Name:OBEN, FRANKLINE TAKUNAW
Entity Type:Individual
Prefix:
First Name:FRANKLINE
Middle Name:TAKUNAW
Last Name:OBEN
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 1:304 RADIANT CT
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-8847
Mailing Address - Country:US
Mailing Address - Phone:240-418-6710
Mailing Address - Fax:
Practice Address - Street 1:11930 ACTON LN
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601-3689
Practice Address - Country:US
Practice Address - Phone:301-705-7040
Practice Address - Fax:301-705-7945
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22638183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist