Provider Demographics
NPI:1548580244
Name:KAMDEM, EDWIGE KOUNGA (PHARMD)
Entity Type:Individual
Prefix:
First Name:EDWIGE
Middle Name:KOUNGA
Last Name:KAMDEM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 KEAYNE ST
Mailing Address - Street 2:
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151-1822
Mailing Address - Country:US
Mailing Address - Phone:781-629-5150
Mailing Address - Fax:
Practice Address - Street 1:467 BROADWAY
Practice Address - Street 2:
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-3030
Practice Address - Country:US
Practice Address - Phone:781-289-8656
Practice Address - Fax:781-289-1962
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA27207183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist