Provider Demographics
NPI:1215318563
Name:ADIMA, NOMANA EFESEKE
Entity type:Individual
Prefix:
First Name:NOMANA
Middle Name:EFESEKE
Last Name:ADIMA
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 1:3627A OLD MILFORD MILL RD
Mailing Address - Street 2:
Mailing Address - City:WINDSOR MILL
Mailing Address - State:MD
Mailing Address - Zip Code:21244-3725
Mailing Address - Country:US
Mailing Address - Phone:410-805-7308
Mailing Address - Fax:
Practice Address - Street 1:122 CRANBROOK RD
Practice Address - Street 2:
Practice Address - City:COCKEYSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21030-3405
Practice Address - Country:US
Practice Address - Phone:410-628-4190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-12
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23166183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist