Provider Demographics
NPI:1134769003
Name:AHUBELEM, UGOCHUKWU
Entity type:Individual
Prefix:
First Name:UGOCHUKWU
Middle Name:
Last Name:AHUBELEM
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 1:19 SUTTON CT
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-1424
Mailing Address - Country:US
Mailing Address - Phone:240-460-4470
Mailing Address - Fax:
Practice Address - Street 1:10692 CAMPUS WAY S
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-1307
Practice Address - Country:US
Practice Address - Phone:301-375-7450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-08
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27027183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist