Provider Demographics
NPI:1801117965
Name:ISONG, EMMANUEL JUMBO
Entity type:Individual
Prefix:MR
First Name:EMMANUEL
Middle Name:JUMBO
Last Name:ISONG
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 1:608 GARDEN VIEW SQ
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-6099
Mailing Address - Country:US
Mailing Address - Phone:301-527-6934
Mailing Address - Fax:301-527-6935
Practice Address - Street 1:3000 CONNECTICUT AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-2509
Practice Address - Country:US
Practice Address - Phone:202-265-1300
Practice Address - Fax:202-234-5832
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-11
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPHA23875183500000X
MD11227183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist