Provider Demographics
NPI:1114520921
Name:EBINUM, CYRIL
Entity type:Individual
Prefix:
First Name:CYRIL
Middle Name:
Last Name:EBINUM
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 1:804 MAINE AVE SW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20024-2494
Mailing Address - Country:US
Mailing Address - Phone:202-488-1428
Mailing Address - Fax:202-558-4704
Practice Address - Street 1:804 MAINE AVE SW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20024-2494
Practice Address - Country:US
Practice Address - Phone:202-488-1428
Practice Address - Fax:202-558-4704
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPHA2925183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist