Provider Demographics
NPI:1023417706
Name:ETCHU, IYVONNE OJONG (PHARMD)
Entity type:Individual
Prefix:DR
First Name:IYVONNE
Middle Name:OJONG
Last Name:ETCHU
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-8527
Mailing Address - Country:US
Mailing Address - Phone:301-694-3390
Mailing Address - Fax:301-694-8671
Practice Address - Street 1:901 W 7TH ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-8527
Practice Address - Country:US
Practice Address - Phone:301-694-3390
Practice Address - Fax:301-694-8671
Is Sole Proprietor?:No
Enumeration Date:2014-08-18
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17214183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist