Provider Demographics
NPI:1336745579
Name:OBI-EYISI, OBINNA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:OBINNA
Middle Name:
Last Name:OBI-EYISI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2333 LACONIA CT
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-3227
Mailing Address - Country:US
Mailing Address - Phone:917-279-9018
Mailing Address - Fax:
Practice Address - Street 1:661 PENNSYLVANIA AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-4303
Practice Address - Country:US
Practice Address - Phone:202-543-3305
Practice Address - Fax:202-548-3082
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20615183500000X
DCPH100000995183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist