Provider Demographics
NPI:1144520628
Name:OBENG-MENSAH, CHARLES (RPH)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:
Last Name:OBENG-MENSAH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4240 MERCHANT PLZ
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-5086
Mailing Address - Country:US
Mailing Address - Phone:703-590-0471
Mailing Address - Fax:703-590-1848
Practice Address - Street 1:4240 MERCHANT PLZ
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-5086
Practice Address - Country:US
Practice Address - Phone:703-590-0471
Practice Address - Fax:703-590-1848
Is Sole Proprietor?:No
Enumeration Date:2010-10-29
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202011524183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist