Provider Demographics
NPI:1699483396
Name:KIMMO, JEMAL DEMMA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JEMAL
Middle Name:DEMMA
Last Name:KIMMO
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 1:6733 NEW HAMPSHIRE AVE APT 410
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-2845
Mailing Address - Country:US
Mailing Address - Phone:202-372-6871
Mailing Address - Fax:
Practice Address - Street 1:3839 MINNESOTA AVE NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-2660
Practice Address - Country:US
Practice Address - Phone:202-388-1900
Practice Address - Fax:202-388-8099
Is Sole Proprietor?:No
Enumeration Date:2022-11-10
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPH100001647183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist