Healthcare Provider Details

I. General information

NPI: 1215529375
Provider Name (Legal Business Name): LUCIEN FREJUS FEUNKEU RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2021
Last Update Date: 10/09/2021
Certification Date: 10/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13307 NEW HAMPSHIRE AVE
SILVER SPRING MD
20904-3435
US

IV. Provider business mailing address

13307 NEW HAMPSHIRE AVE
SILVER SPRING MD
20904-3435
US

V. Phone/Fax

Practice location:
  • Phone: 301-384-0487
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number25648
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: