Basic Information
| Provider Information | |||||||||
| NPI: | 1619987534 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | IHEAGWARA | ||||||||
| FirstName: | NNENNA | ||||||||
| MiddleName: | LILLIAN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PHARMD, BCPS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7520 HELSTON CT | ||||||||
| Address2: | |||||||||
| City: | HANOVER | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210761923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2156205306 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 10 N GREENE ST # 119 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212011524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106057000 | ||||||||
| FaxNumber: | 4106057852 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2006 | ||||||||
| LastUpdateDate: | 04/28/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1835P1200X | 17291 | MD | Y | Pharmacy Service Providers | Pharmacist | Pharmacotherapy | 1835P1200X | RP439488 | PA | N | Pharmacy Service Providers | Pharmacist | Pharmacotherapy | 1835P1200X | A1-0003507 | DE | N | Pharmacy Service Providers | Pharmacist | Pharmacotherapy |
No ID Information.