Provider Demographics
NPI:1831499292
Name:MADUKA, JASON CHIGOZIE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JASON
Middle Name:CHIGOZIE
Last Name:MADUKA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10705 LAKE ARBOR WAY
Mailing Address - Street 2:
Mailing Address - City:MITCHELLVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-3138
Mailing Address - Country:US
Mailing Address - Phone:301-867-0345
Mailing Address - Fax:301-867-0344
Practice Address - Street 1:12410 FAIRWOOD PKWY
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20720-6312
Practice Address - Country:US
Practice Address - Phone:301-867-0345
Practice Address - Fax:301-867-0344
Is Sole Proprietor?:No
Enumeration Date:2010-11-01
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13011183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist