Provider Demographics
NPI:1972517829
Name:IBEGBU, MARY-ATTRACTA (RPH, PHARMD)
Entity type:Individual
Prefix:DR
First Name:MARY-ATTRACTA
Middle Name:
Last Name:IBEGBU
Suffix:
Gender:F
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23309 HYACINTH LN
Mailing Address - Street 2:
Mailing Address - City:CALIFORNIA
Mailing Address - State:MD
Mailing Address - Zip Code:20619-6173
Mailing Address - Country:US
Mailing Address - Phone:716-880-9838
Mailing Address - Fax:
Practice Address - Street 1:24288 THREE NOTCH RD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:MD
Practice Address - Zip Code:20636-4628
Practice Address - Country:US
Practice Address - Phone:301-373-3113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23222183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist