Provider Demographics
NPI:1255645396
Name:MEZU, OGECHI V (PHARMD)
Entity type:Individual
Prefix:DR
First Name:OGECHI
Middle Name:V
Last Name:MEZU
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9916 LIBERTY RD
Mailing Address - Street 2:
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-1804
Mailing Address - Country:US
Mailing Address - Phone:443-272-7641
Mailing Address - Fax:443-272-7649
Practice Address - Street 1:9916 LIBERTY RD
Practice Address - Street 2:
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-1804
Practice Address - Country:US
Practice Address - Phone:443-272-7641
Practice Address - Fax:443-272-7649
Is Sole Proprietor?:No
Enumeration Date:2010-07-30
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18989183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist