Provider Demographics
NPI:1164142857
Name:BAH, MARLYSE (RPH)
Entity Type:Individual
Prefix:
First Name:MARLYSE
Middle Name:
Last Name:BAH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17134 DOWNING ST APT 302
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-3631
Mailing Address - Country:US
Mailing Address - Phone:832-758-9899
Mailing Address - Fax:
Practice Address - Street 1:19901 FREDERICK RD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20876-4005
Practice Address - Country:US
Practice Address - Phone:832-758-9899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-01
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD28298183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist