Provider Demographics
NPI:1700369972
Name:KAMLEU, MARYSA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARYSA
Middle Name:
Last Name:KAMLEU
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 1:13306 WATERSIDE CIR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-3734
Mailing Address - Country:US
Mailing Address - Phone:301-233-3542
Mailing Address - Fax:
Practice Address - Street 1:799 ROCKVILLE PIKE
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-1136
Practice Address - Country:US
Practice Address - Phone:301-340-2683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-12
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25965183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist