Provider Demographics
NPI:1811306970
Name:EBEKONYE, BASIL CHINENYE (RPH)
Entity type:Individual
Prefix:MR
First Name:BASIL
Middle Name:CHINENYE
Last Name:EBEKONYE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7095 BALTIMORE ANNAPOLIS BLVD
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-1431
Mailing Address - Country:US
Mailing Address - Phone:410-859-3113
Mailing Address - Fax:410-691-2646
Practice Address - Street 1:7095 BALTIMORE ANNAPOLIS BLVD
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-1431
Practice Address - Country:US
Practice Address - Phone:410-859-3113
Practice Address - Fax:410-691-2646
Is Sole Proprietor?:No
Enumeration Date:2014-08-03
Last Update Date:2014-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12459183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist