Active NPI
Chukwuma Ibetoh, PHARMD
- Pharmacist
- Upper Marlboro, MD
National Provider Identifier
1811366735
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 17312
- Practice address
- 10692 Campus Way S
Upper Marlboro, MD 20774-1307 - Phone
- (301) 336-2900
- NPI assigned
- Sep 22, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 17312 | MD | Primary |
| Pharmacist | 183500000X | PH100000934 | DC |
Addresses
Primary practice location
10692 Campus Way S
Upper Marlboro, MD 20774-1307
Mailing address
10692 Campus Way S
Upper Marlboro, MD 20774-1307
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17312 | MD | MD | General Practice Dentistry |
| PH100000934 | DC | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1442880000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1442880000000",
"number": "1811366735",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10692 CAMPUS WAY S",
"city": "UPPER MARLBORO",
"state": "MD",
"postal_code": "207741307"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10692 CAMPUS WAY S",
"city": "UPPER MARLBORO",
"state": "MD",
"postal_code": "207741307",
"telephone_number": "301-336-2900"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IBETOH",
"first_name": "CHUKWUMA",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-09-22",
"last_updated": "2015-09-22",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MD",
"license": "17312",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "DC",
"license": "PH100000934",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Upper Marlboro, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.