Provider Demographics
NPI:1225304124
Name:MISSENDA, MARYBETH (RPH)
Entity Type:Individual
Prefix:
First Name:MARYBETH
Middle Name:
Last Name:MISSENDA
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 1:7045 BERRY RD UNIT A5
Mailing Address - Street 2:BOX 361
Mailing Address - City:ACCOKEEK
Mailing Address - State:MD
Mailing Address - Zip Code:20607-3440
Mailing Address - Country:US
Mailing Address - Phone:412-334-2501
Mailing Address - Fax:
Practice Address - Street 1:16833 HOLLY WAY
Practice Address - Street 2:
Practice Address - City:ACCOKEEK
Practice Address - State:MD
Practice Address - Zip Code:20607-9714
Practice Address - Country:US
Practice Address - Phone:412-334-2501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPH1000000441835N1003X
PARP036731L1835N1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835N1003XPharmacy Service ProvidersPharmacistNutrition Support