Provider Demographics
NPI:1902219082
Name:UMEH, THEODORE UGO
Entity Type:Individual
Prefix:MR
First Name:THEODORE
Middle Name:UGO
Last Name:UMEH
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 1:3250 SUPERIOR LN
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-1916
Mailing Address - Country:US
Mailing Address - Phone:301-805-1866
Mailing Address - Fax:301-805-1859
Practice Address - Street 1:3250 SUPERIOR LN
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-1916
Practice Address - Country:US
Practice Address - Phone:301-805-1866
Practice Address - Fax:301-805-1859
Is Sole Proprietor?:No
Enumeration Date:2014-06-06
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17897183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist