Provider Demographics
NPI:1235950577
Name:BLUE RIDGE HEALTH SOLUTIONS LLC
Entity type:Organization
Organization Name:BLUE RIDGE HEALTH SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MORONKE
Authorized Official - Middle Name:A
Authorized Official - Last Name:OBARO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:240-354-5818
Mailing Address - Street 1:2680 EVERGREEN RD
Mailing Address - Street 2:
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-2311
Mailing Address - Country:US
Mailing Address - Phone:240-354-5818
Mailing Address - Fax:
Practice Address - Street 1:1053 MD RT 3 N STE 4
Practice Address - Street 2:
Practice Address - City:GAMBRILLS
Practice Address - State:MD
Practice Address - Zip Code:21054-1781
Practice Address - Country:US
Practice Address - Phone:240-354-5818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-19
Last Update Date:2024-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistGroup - Single Specialty
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy