Provider Demographics
NPI:1770160988
Name:FORCHAP, AUSTIN AYUK
Entity type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:AYUK
Last Name:FORCHAP
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 1:307 OAK MANOR DR APT 101
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-6707
Mailing Address - Country:US
Mailing Address - Phone:443-929-8639
Mailing Address - Fax:
Practice Address - Street 1:1102 ANNAPOLIS RD
Practice Address - Street 2:
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113-1602
Practice Address - Country:US
Practice Address - Phone:410-674-8338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27816183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD47904624200Medicaid