Provider Demographics
NPI:1427361278
Name:TAJONG, KENNETH CHABEJAH (RPH)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:CHABEJAH
Last Name:TAJONG
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 CHARTLEY DR
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-2306
Mailing Address - Country:US
Mailing Address - Phone:410-833-4046
Mailing Address - Fax:
Practice Address - Street 1:2043 MONDAWMIN MALL
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215
Practice Address - Country:US
Practice Address - Phone:410-523-6315
Practice Address - Fax:410-523-4796
Is Sole Proprietor?:No
Enumeration Date:2010-07-22
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17396183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist