Provider Demographics
NPI:1326440876
Name:KEMELONG, PASCAL
Entity Type:Individual
Prefix:
First Name:PASCAL
Middle Name:
Last Name:KEMELONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21676 GREAT MILLS RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20653-3806
Mailing Address - Country:US
Mailing Address - Phone:301-863-3132
Mailing Address - Fax:301-863-5631
Practice Address - Street 1:21676 GREAT MILLS RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON PARK
Practice Address - State:MD
Practice Address - Zip Code:20653-3806
Practice Address - Country:US
Practice Address - Phone:301-863-3132
Practice Address - Fax:301-863-5631
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19366183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist