Provider Demographics
NPI:1245781921
Name:KANIMBA, CHRISTOPHER (PHARM D)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:KANIMBA
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19901 FREDERICK RD
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20876-4005
Mailing Address - Country:US
Mailing Address - Phone:301-418-5504
Mailing Address - Fax:
Practice Address - Street 1:19901 FREDERICK RD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20876-4005
Practice Address - Country:US
Practice Address - Phone:301-418-5504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23831183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist