Provider Demographics
NPI:1184496077
Name:MUKETE, SYLVESTER MUDIME
Entity type:Individual
Prefix:
First Name:SYLVESTER
Middle Name:MUDIME
Last Name:MUKETE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3320 GALENA DR APT 210
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21704-7484
Mailing Address - Country:US
Mailing Address - Phone:240-315-3376
Mailing Address - Fax:
Practice Address - Street 1:1275 W PATRICK ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4886
Practice Address - Country:US
Practice Address - Phone:301-668-8716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD28962183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist