Healthcare Provider Details

I. General information

NPI: 1831006840
Provider Name (Legal Business Name): CYNTHIA KAMGA FANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 HIGH ST
WALDORF MD
20602-1842
US

IV. Provider business mailing address

25 HIGH ST
WALDORF MD
20602-1842
US

V. Phone/Fax

Practice location:
  • Phone: 301-932-9826
  • Fax: 301-932-4294
Mailing address:
  • Phone: 301-932-9826
  • Fax: 301-932-4294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number31103
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: