Provider Demographics
NPI:1538575261
Name:NDIMASA, ERIC NDOUMBE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:NDOUMBE
Last Name:NDIMASA
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 1:22565 THREE NOTCH ROAD
Mailing Address - Street 2:
Mailing Address - City:CALIFORNIA
Mailing Address - State:MD
Mailing Address - Zip Code:20619
Mailing Address - Country:US
Mailing Address - Phone:301-863-5992
Mailing Address - Fax:301-866-1497
Practice Address - Street 1:22565 THREE NOTCH ROAD
Practice Address - Street 2:
Practice Address - City:CALIFORNIA
Practice Address - State:MD
Practice Address - Zip Code:20619
Practice Address - Country:US
Practice Address - Phone:301-863-5992
Practice Address - Fax:301-866-1497
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20415183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist