Provider Demographics
NPI:1720503774
Name:OGWENO, BRIAN W (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:W
Last Name:OGWENO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:BRIAN
Other - Middle Name:ALEXANDER
Other - Last Name:OGWENO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1046 COPPERSTONE CT
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-1143
Mailing Address - Country:US
Mailing Address - Phone:816-400-3044
Mailing Address - Fax:
Practice Address - Street 1:7955 TUCKERMAN LN
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20854-3243
Practice Address - Country:US
Practice Address - Phone:301-299-3717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-11
Last Update Date:2017-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012027069183500000X
MD23861183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist