Provider Demographics
NPI:1801205083
Name:ETUNNUH, UCHE MOSES (PHARMD)
Entity Type:Individual
Prefix:
First Name:UCHE
Middle Name:MOSES
Last Name:ETUNNUH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3307 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21207-4509
Mailing Address - Country:US
Mailing Address - Phone:443-415-6313
Mailing Address - Fax:
Practice Address - Street 1:3307 FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21207-4509
Practice Address - Country:US
Practice Address - Phone:443-415-6313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-12
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21726183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist