1336745579 NPI number — DR. OBINNA OBI-EYISI PHARMD

Table of content: DR. OBINNA OBI-EYISI PHARMD (NPI 1336745579)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336745579 NPI number — DR. OBINNA OBI-EYISI PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OBI-EYISI
Provider First Name:
OBINNA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336745579
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/10/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2333 LACONIA CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CROFTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21114-3227
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-279-9018
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
661 PENNSYLVANIA AVE SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20003-4303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-543-3305
Provider Business Practice Location Address Fax Number:
202-548-3082
Provider Enumeration Date:
12/10/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  20615 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 183500000X , with the licence number: PH100000995 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)