Provider Demographics
NPI:1316255615
Name:ANUKAM, NNAMDI A (BPHARM)
Entity type:Individual
Prefix:
First Name:NNAMDI
Middle Name:A
Last Name:ANUKAM
Suffix:
Gender:M
Credentials:BPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12706 CONWOOD CT
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-9314
Mailing Address - Country:US
Mailing Address - Phone:301-910-2956
Mailing Address - Fax:
Practice Address - Street 1:110 MITCHELLS CHANCE RD
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:MD
Practice Address - Zip Code:21037-2740
Practice Address - Country:US
Practice Address - Phone:410-956-9411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16579183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist