Provider Demographics
NPI:1407451032
Name:JOSEPH, EXAMENE
Entity Type:Individual
Prefix:
First Name:EXAMENE
Middle Name:
Last Name:JOSEPH
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 1:1461 N HIGHVIEW LN APT 312
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22311-2332
Mailing Address - Country:US
Mailing Address - Phone:954-706-0256
Mailing Address - Fax:
Practice Address - Street 1:6221 OXON HILL RD APT 312
Practice Address - Street 2:
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-3010
Practice Address - Country:US
Practice Address - Phone:301-839-0667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27692183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist