Healthcare Provider Details

I. General information

NPI: 1295134427
Provider Name (Legal Business Name): ANNIE PHUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2014
Last Update Date: 08/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9420 LANHAM SEVERN RD
LANHAM MD
20706-2642
US

IV. Provider business mailing address

1905 MIDDLEBRIDGE DR
SILVER SPRING MD
20906-5821
US

V. Phone/Fax

Practice location:
  • Phone: 301-577-5555
  • Fax:
Mailing address:
  • Phone: 301-448-2566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number21852
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: