Provider Demographics
NPI:1962772525
Name:ANIBABA, OMOWUNMI MAUREEN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:OMOWUNMI
Middle Name:MAUREEN
Last Name:ANIBABA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9882 DECATUR RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-3777
Mailing Address - Country:US
Mailing Address - Phone:410-790-4365
Mailing Address - Fax:
Practice Address - Street 1:702 EDGEWOOD RD
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:MD
Practice Address - Zip Code:21040-2400
Practice Address - Country:US
Practice Address - Phone:410-671-9780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-12
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20360183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist