Provider Demographics
NPI:1942780184
Name:KONGCHI, KENGNE CLOVIS (PHARMD)
Entity Type:Individual
Prefix:
First Name:KENGNE
Middle Name:CLOVIS
Last Name:KONGCHI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10305 ARETHUSA LN
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-4380
Mailing Address - Country:US
Mailing Address - Phone:240-467-1328
Mailing Address - Fax:
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:
Is Sole Proprietor?:No
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25849183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist