Basic Information
| Provider Information | |||||||||
| NPI: | 1235471582 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MBAH | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | O | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14420 BURSLEM TER | ||||||||
| Address2: | |||||||||
| City: | BURTONSVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208662014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3018907715 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6104 OLD BRANCH AVE | ||||||||
| Address2: | |||||||||
| City: | TEMPLE HILLS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207482518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017026100 | ||||||||
| FaxNumber: | 3017026118 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2013 | ||||||||
| LastUpdateDate: | 03/25/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1835P0018X | 13411 | MD | Y | Pharmacy Service Providers | Pharmacist | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
No ID Information.