Provider Demographics
NPI:1356778666
Name:MESUMBE, ROSINA GRACE EPOLLE (PHARMD)
Entity type:Individual
Prefix:
First Name:ROSINA GRACE
Middle Name:EPOLLE
Last Name:MESUMBE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 CENTENNIAL LN
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-3600
Mailing Address - Country:US
Mailing Address - Phone:410-750-9439
Mailing Address - Fax:
Practice Address - Street 1:3300 CENTENNIAL LN
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-3600
Practice Address - Country:US
Practice Address - Phone:410-750-9439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-01
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27506183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA