Provider Demographics
NPI:1457234312
Name:EKANEM, MFON
Entity type:Individual
Prefix:
First Name:MFON
Middle Name:
Last Name:EKANEM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4102 HATLEY PL
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:MD
Mailing Address - Zip Code:20695-4295
Mailing Address - Country:US
Mailing Address - Phone:301-272-0278
Mailing Address - Fax:
Practice Address - Street 1:4102 HATLEY PL
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:MD
Practice Address - Zip Code:20695-4295
Practice Address - Country:US
Practice Address - Phone:301-272-0278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-29
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202216513183500000X
DCPH100003230183500000X
MD25402183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist