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NPI Code Detail

MEDICARE: KENGNE CLOVIS KONGCHI PHARMD

MEDICARE:   KENGNE CLOVIS KONGCHI  PHARMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist25849MD

General Provider Information

NPI Number : 1942780184
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENGNE CLOVIS KONGCHI PHARMD
Provider Business Mailing Address
First Line : 10305 ARETHUSA LN
Second Line :
City : UPPER MARLBORO
State : MD
Zip : 20772-4380
Country : US
Telephone Number : 240-467-1328
Fax Number :
Provider Business Practice Location Address
First Line : 7012 MARLBORO PIKE
Second Line :
City : FORESTVILLE
State : MD
Zip : 20747-3242
Country : US
Telephone Number : 301-736-8683
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/17/2018
Last Update Date : 08/17/2018

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Directions to “ KENGNE CLOVIS KONGCHI PHARMD” Practice Location

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