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General NPI Number Information
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NPI Number | 1245756899
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Entity Type | Individual
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Provider Name | BRONESSA S FERNANDES PHARM D
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Gender | Female
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Dates
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Enumeration Date | 08/16/2017
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Last Update Date | 08/16/2017
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Provider Practice Location Address
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Address Line | 14101 DARNESTOWN RD
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City | GERMANTOWN
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State | MD
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Zip | 20874-3009
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Country | US
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Telephone | 240-631-9629
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Fax | 240-631-9724
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Provider Business Mailing Address
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Address Line | 18317 QUONDAL CT
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City | GAITHERSBURG
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State | MD
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Zip | 20877-3863
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Country | US
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Telephone | 240-422-4999
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 23378
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License Number State | MD
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