Provider Demographics
NPI:1104046960
Name:EJINDU, NWANNE
Entity type:Individual
Prefix:
First Name:NWANNE
Middle Name:
Last Name:EJINDU
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 1:3520 RIPPLING WAY
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20724-1703
Mailing Address - Country:US
Mailing Address - Phone:301-604-6402
Mailing Address - Fax:
Practice Address - Street 1:3520 RIPPLING WAY
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20724-1703
Practice Address - Country:US
Practice Address - Phone:301-604-6402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16399183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist