Provider Demographics
NPI:1063096931
Name:KONDOS, RAYMONDA
Entity type:Individual
Prefix:
First Name:RAYMONDA
Middle Name:
Last Name:KONDOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4215 CONNECTICUT AVE NW STE 1
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-1159
Mailing Address - Country:US
Mailing Address - Phone:202-244-7979
Mailing Address - Fax:202-244-7977
Practice Address - Street 1:4215 CONNECTICUT AVE NW STE 1
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-1159
Practice Address - Country:US
Practice Address - Phone:202-244-7979
Practice Address - Fax:202-244-7977
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-07
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPH100000304183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCPH100000304OtherBOARD OF PHARMACY