Provider Demographics
NPI:1306425756
Name:UMOREN, EDIDIONG RUTH, INIOLUWA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:EDIDIONG
Middle Name:RUTH, INIOLUWA
Last Name:UMOREN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:EDIDIONG
Other - Middle Name:RUTH, INIOLUWA
Other - Last Name:DEMUREN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:8525 CHEVY CHASE LAKE TER APT 431
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-4088
Mailing Address - Country:US
Mailing Address - Phone:770-310-2383
Mailing Address - Fax:
Practice Address - Street 1:1701 N GEORGE MASON DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205-3610
Practice Address - Country:US
Practice Address - Phone:703-717-7750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-05
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPH100004174183500000X
VA0202220930183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist