Healthcare Provider Details

I. General information

NPI: 1831821628
Provider Name (Legal Business Name): MADIGBE CISSE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2022
Last Update Date: 07/05/2022
Certification Date: 07/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11221 NEW HAMPSHIRE AVE
SILVER SPRING MD
20904-2631
US

IV. Provider business mailing address

11221 NEW HAMPSHIRE AVE
SILVER SPRING MD
20904-2631
US

V. Phone/Fax

Practice location:
  • Phone: 301-681-8310
  • Fax:
Mailing address:
  • Phone: 240-247-7489
  • Fax: 844-411-6324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28581
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: