Provider Demographics
NPI:1952901555
Name:AHWAH, CHANTAL JACQUELINE
Entity Type:Individual
Prefix:DR
First Name:CHANTAL
Middle Name:JACQUELINE
Last Name:AHWAH
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 1:12810 ODENS BEQUEST DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-5614
Mailing Address - Country:US
Mailing Address - Phone:301-437-0766
Mailing Address - Fax:
Practice Address - Street 1:10600 TOWN CENTER BLVD
Practice Address - Street 2:
Practice Address - City:DUNKIRK
Practice Address - State:MD
Practice Address - Zip Code:20754-2737
Practice Address - Country:US
Practice Address - Phone:410-257-2913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-01
Last Update Date:2020-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18883183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist