Provider Demographics
NPI:1972257160
Name:NWABUNIKE, MARTIN BONIFACE (RPH)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:BONIFACE
Last Name:NWABUNIKE
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:PO BOX 66124
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21239-6124
Mailing Address - Country:US
Mailing Address - Phone:443-722-2640
Mailing Address - Fax:
Practice Address - Street 1:716 DULANEY VALLEY RD
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-5109
Practice Address - Country:US
Practice Address - Phone:410-323-0108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11068183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty