Healthcare Provider Details

I. General information

NPI: 1700369972
Provider Name (Legal Business Name): MARYSA KAMLEU PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2018
Last Update Date: 09/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

799 ROCKVILLE PIKE
ROCKVILLE MD
20852-1136
US

IV. Provider business mailing address

13306 WATERSIDE CIR
GERMANTOWN MD
20874-3734
US

V. Phone/Fax

Practice location:
  • Phone: 301-340-2683
  • Fax:
Mailing address:
  • Phone: 301-233-3542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number25965
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: