Provider Demographics
NPI:1083966956
Name:MOFFOR, PASCALINE NGIE
Entity Type:Individual
Prefix:MISS
First Name:PASCALINE
Middle Name:NGIE
Last Name:MOFFOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13020 RAINTREE TER
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-5272
Mailing Address - Country:US
Mailing Address - Phone:240-559-7357
Mailing Address - Fax:
Practice Address - Street 1:13020 RAINTREE TER
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-5272
Practice Address - Country:US
Practice Address - Phone:904-536-3738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-03
Last Update Date:2021-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC374U00000X
MD26565183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No374U00000XNursing Service Related ProvidersHome Health Aide