Provider Demographics
NPI:1144833914
Name:SIMON-EBUGHU, CHIOMA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CHIOMA
Middle Name:
Last Name:SIMON-EBUGHU
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 REMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21211-3025
Mailing Address - Country:US
Mailing Address - Phone:410-235-2128
Mailing Address - Fax:
Practice Address - Street 1:2700 REMINGTON AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211-3025
Practice Address - Country:US
Practice Address - Phone:410-235-2128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-31
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27529183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS551115009699OtherDRIVERS LICENSE