Provider Demographics
NPI:1508274283
Name:KIBBE, RANTA
Entity Type:Individual
Prefix:
First Name:RANTA
Middle Name:
Last Name:KIBBE
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 1:9950 LEWIS DR
Mailing Address - Street 2:
Mailing Address - City:DAMASCUS
Mailing Address - State:MD
Mailing Address - Zip Code:20872-1706
Mailing Address - Country:US
Mailing Address - Phone:301-253-5454
Mailing Address - Fax:301-253-0017
Practice Address - Street 1:9950 LEWIS DR
Practice Address - Street 2:
Practice Address - City:DAMASCUS
Practice Address - State:MD
Practice Address - Zip Code:20872-1706
Practice Address - Country:US
Practice Address - Phone:301-253-5454
Practice Address - Fax:301-253-0017
Is Sole Proprietor?:No
Enumeration Date:2014-07-26
Last Update Date:2014-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09616183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist