Provider Demographics
NPI:1992290860
Name:MBI, EMMANUEL A (PHARMD)
Entity type:Individual
Prefix:DR
First Name:EMMANUEL
Middle Name:A
Last Name:MBI
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 1:15300 RIDING PATH CT
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-5445
Mailing Address - Country:US
Mailing Address - Phone:240-476-8421
Mailing Address - Fax:
Practice Address - Street 1:5722 RITCHIE HWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MD
Practice Address - Zip Code:21225-3641
Practice Address - Country:US
Practice Address - Phone:410-636-9779
Practice Address - Fax:410-636-9783
Is Sole Proprietor?:No
Enumeration Date:2018-06-24
Last Update Date:2018-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD167051835P2201X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care