Provider Demographics
NPI:1548730005
Name:ALEAHMBONG, NICAR (PHARMD)
Entity type:Individual
Prefix:
First Name:NICAR
Middle Name:
Last Name:ALEAHMBONG
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 1:15205 JERRINGTON CT
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-7270
Mailing Address - Country:US
Mailing Address - Phone:443-822-1188
Mailing Address - Fax:
Practice Address - Street 1:2855 SMITH AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-1426
Practice Address - Country:US
Practice Address - Phone:419-484-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-27
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD26062183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist