Provider Demographics
NPI:1891134516
Name:IJEABUONWU, OBIESIEMIKE
Entity Type:Individual
Prefix:
First Name:OBIESIEMIKE
Middle Name:
Last Name:IJEABUONWU
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 1:9307 HOBART ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5413
Mailing Address - Country:US
Mailing Address - Phone:202-450-3655
Mailing Address - Fax:
Practice Address - Street 1:1219 BRENTWOOD RD NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-1019
Practice Address - Country:US
Practice Address - Phone:202-450-3655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-15
Last Update Date:2013-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPHA3260183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCPHA3260OtherPHARMACIST