Provider Demographics
NPI:1407459324
Name:ADZAKLO, KUDZO ADEM
Entity Type:Individual
Prefix:
First Name:KUDZO
Middle Name:ADEM
Last Name:ADZAKLO
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 1:419 MUDDY BRANCH RD APT 301
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-2953
Mailing Address - Country:US
Mailing Address - Phone:240-715-8210
Mailing Address - Fax:
Practice Address - Street 1:8750 ARLISS ST
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-3905
Practice Address - Country:US
Practice Address - Phone:301-585-2777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-21
Last Update Date:2020-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27604183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist