Provider Demographics
NPI:1871852780
Name:EWAH, CAROL
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:
Last Name:EWAH
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 1:8800 BARNSLEY CT APT 14
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-3469
Mailing Address - Country:US
Mailing Address - Phone:240-264-0651
Mailing Address - Fax:
Practice Address - Street 1:13607 AVEBURY DR
Practice Address - Street 2:APT 32
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708
Practice Address - Country:US
Practice Address - Phone:240-486-6294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-11
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24221183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist