Provider Demographics
NPI:1013467927
Name:MAMO, EFREM (RPH)
Entity Type:Individual
Prefix:MR
First Name:EFREM
Middle Name:
Last Name:MAMO
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 1:6881 NEW HAMPSHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-4816
Mailing Address - Country:US
Mailing Address - Phone:301-270-2638
Mailing Address - Fax:301-270-2853
Practice Address - Street 1:6881 NEW HAMPSHIRE AVE
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-4816
Practice Address - Country:US
Practice Address - Phone:301-270-2638
Practice Address - Fax:301-270-2853
Is Sole Proprietor?:No
Enumeration Date:2016-10-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14256183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist