Healthcare Provider Details

I. General information

NPI: 1417851361
Provider Name (Legal Business Name): JIN WEN WANG PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JIN WANG PHARMD

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 N RIDGE RD
ELLICOTT CITY MD
21043-3363
US

IV. Provider business mailing address

4232 BAR HARBOR PL
OLNEY MD
20832-2967
US

V. Phone/Fax

Practice location:
  • Phone: 410-418-9703
  • Fax:
Mailing address:
  • Phone: 240-619-0696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number31200
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: