Healthcare Provider Details

I. General information

NPI: 1679948871
Provider Name (Legal Business Name): JAMES WANG PHARMD, BCPS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2015
Last Update Date: 12/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2267 BRIMSTONE PL
HANOVER MD
21076-1871
US

IV. Provider business mailing address

2267 BRIMSTONE PL
HANOVER MD
21076-1871
US

V. Phone/Fax

Practice location:
  • Phone: 301-209-6293
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number20146
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: