Healthcare Provider Details

I. General information

NPI: 1801472188
Provider Name (Legal Business Name): QUEENIVA A ANGUM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2021
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6419 JODIE ST
NEW CARROLLTON MD
20784-3633
US

IV. Provider business mailing address

6419 JODIE ST
NEW CARROLLTON MD
20784-3633
US

V. Phone/Fax

Practice location:
  • Phone: 301-383-5699
  • Fax:
Mailing address:
  • Phone: 301-383-5699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number30603
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: