Provider Demographics
NPI:1932516812
Name:KENMATIO, SUEBANG DOROTHY (PHARMD)
Entity Type:Individual
Prefix:
First Name:SUEBANG
Middle Name:DOROTHY
Last Name:KENMATIO
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 1:7012 MARLBORO PIKE
Mailing Address - Street 2:
Mailing Address - City:FORESTVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20747-3242
Mailing Address - Country:US
Mailing Address - Phone:301-736-8683
Mailing Address - Fax:301-516-8234
Practice Address - Street 1:7012 MARLBORO PIKE
Practice Address - Street 2:
Practice Address - City:FORESTVILLE
Practice Address - State:MD
Practice Address - Zip Code:20747-3242
Practice Address - Country:US
Practice Address - Phone:301-736-8683
Practice Address - Fax:301-516-8234
Is Sole Proprietor?:No
Enumeration Date:2014-07-12
Last Update Date:2014-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18037183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist