Provider Demographics
NPI:1780284158
Name:DUODU, CHRISTIANA
Entity type:Individual
Prefix:
First Name:CHRISTIANA
Middle Name:
Last Name:DUODU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16206 TILGHMAN CT
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-2675
Mailing Address - Country:US
Mailing Address - Phone:513-293-8425
Mailing Address - Fax:
Practice Address - Street 1:3549 RUSSETT GRN E
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20724-1810
Practice Address - Country:US
Practice Address - Phone:301-604-0148
Practice Address - Fax:301-604-2839
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20034183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist