Provider Demographics
NPI:1700485240
Name:MBAH, RELINDIS (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RELINDIS
Middle Name:
Last Name:MBAH
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 1:18700 N VILLAGE
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-2454
Mailing Address - Country:US
Mailing Address - Phone:954-600-2067
Mailing Address - Fax:
Practice Address - Street 1:34 N CANNON AVE
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-4919
Practice Address - Country:US
Practice Address - Phone:301-797-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-24
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0012410183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist