Provider Demographics
NPI:1609119023
Name:KODJO, ASSEMIEN ALEXIS (RPH)
Entity Type:Individual
Prefix:MR
First Name:ASSEMIEN
Middle Name:ALEXIS
Last Name:KODJO
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 1:13729 CONNECTICUT AVE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-2916
Mailing Address - Country:US
Mailing Address - Phone:301-871-7511
Mailing Address - Fax:301-871-4213
Practice Address - Street 1:13729 CONNECTICUT AVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-2916
Practice Address - Country:US
Practice Address - Phone:301-871-7511
Practice Address - Fax:301-871-4213
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14043183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist