Provider Demographics
NPI:1023419017
Name:EZEH, MAUREEN
Entity type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:
Last Name:EZEH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3918 LUMO CIR
Mailing Address - Street 2:
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-3647
Mailing Address - Country:US
Mailing Address - Phone:214-395-6891
Mailing Address - Fax:
Practice Address - Street 1:1141 MERRITT BLVD
Practice Address - Street 2:
Practice Address - City:DUNDALK
Practice Address - State:MD
Practice Address - Zip Code:21222-1438
Practice Address - Country:US
Practice Address - Phone:410-282-7500
Practice Address - Fax:410-282-7503
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22245183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist