Provider Demographics
NPI:1154890895
Name:OGOLLA, JULIANA ATIENO
Entity type:Individual
Prefix:
First Name:JULIANA
Middle Name:ATIENO
Last Name:OGOLLA
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 1:17 ALICEVIEW CT
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-3370
Mailing Address - Country:US
Mailing Address - Phone:410-252-3146
Mailing Address - Fax:
Practice Address - Street 1:4126 E JOPPA RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21236-2223
Practice Address - Country:US
Practice Address - Phone:410-529-3045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-23
Last Update Date:2018-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20571183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist