| Doctor Name: | MARYBETH MISSENDA |
| NPI Number: | 1225304124 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RPH |
| License Number: | PH100000044 |
| Business Practice Address: | 16833 Holly Way Accokeek, MD - 206079714 |
| Business Phone Number: | 4123342501 |
| Business Fax Number: | |
| Mailing Address: | 7045 Berry Rd Unit A5, Box 361 ACCOKEEK |
| State: | MD |
| Postal Code: | 206073440 |
| Phone Number: | 4123342501 |
| Fax Number: | |
| NPI Enumeration Date: | 03/26/2012 |
| NPI Last Update Date: | 03/26/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1835N1003X |
| License Number: | PH100000044 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | DC |
| Taxonomy Type: | Pharmacy Service Providers |
| Taxonomy Classification: | Pharmacist |
| Taxonomy Specialization: | Nutrition Support |
| Taxonomy Definition: | A licensed pharmacist who has demonstrated specialized knowledge and skill in maintenance and/or restoration of optimal nutritional status, designing and modifying treatment according to patient needs. |