Provider Demographics
NPI:1972889962
Name:IZAH, AWELE (RPH)
Entity Type:Individual
Prefix:
First Name:AWELE
Middle Name:
Last Name:IZAH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9713 ELDWICK WAY
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-2036
Mailing Address - Country:US
Mailing Address - Phone:240-426-6521
Mailing Address - Fax:
Practice Address - Street 1:10101 RIVER RD
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-4904
Practice Address - Country:US
Practice Address - Phone:240-426-6521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-23
Last Update Date:2011-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPH2355183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCPH2355OtherPHARMACIST LICENSE