Provider Demographics
NPI:1487304465
Name:IMPACT BUSINESS GROUP INC
Entity type:Organization
Organization Name:IMPACT BUSINESS GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRIETTA
Authorized Official - Middle Name:NGOZI
Authorized Official - Last Name:OLOWOYO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-589-6059
Mailing Address - Street 1:8412 GANNON CT
Mailing Address - Street 2:
Mailing Address - City:SEVERN
Mailing Address - State:MD
Mailing Address - Zip Code:21144-3145
Mailing Address - Country:US
Mailing Address - Phone:240-338-0411
Mailing Address - Fax:
Practice Address - Street 1:5704 RITCHIE HWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MD
Practice Address - Zip Code:21225-3641
Practice Address - Country:US
Practice Address - Phone:410-589-6059
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-24
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy