Provider Demographics
NPI:1245679406
Name:ODIFIE, NAA EKUA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:NAA
Middle Name:EKUA
Last Name:ODIFIE
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 1:19005 AMARILLO DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-6140
Mailing Address - Country:US
Mailing Address - Phone:301-515-0647
Mailing Address - Fax:
Practice Address - Street 1:19005 AMARILLO DR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-6140
Practice Address - Country:US
Practice Address - Phone:301-515-0647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-21
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD145351835P0018X
WAPH000224111835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy