Healthcare Provider Details

I. General information

NPI: 1306055611
Provider Name (Legal Business Name): MEKDESE B KASSA PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 W BELVEDERE AVE
BALTIMORE MD
21215-5216
US

IV. Provider business mailing address

5910 CEDAR FERN CT
COLUMBIA MD
21044-3640
US

V. Phone/Fax

Practice location:
  • Phone: 410-601-9303
  • Fax: 410-601-9311
Mailing address:
  • Phone: 410-601-9488
  • Fax: 410-601-9311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number14235
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: