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NPI Code Detail

MEDICARE: ALDA FANSI NGASSA PHARMD

MEDICARE:   ALDA FANSI NGASSA  PHARMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist20401MD

General Provider Information

NPI Number : 1386059590
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALDA FANSI NGASSA PHARMD
Provider Business Mailing Address
First Line : 6622 SECURITY BLVD
Second Line :
City : BALTIMORE
State : MD
Zip : 21207-4010
Country : US
Telephone Number : 410-944-6611
Fax Number : 410-944-0236
Provider Business Practice Location Address
First Line : 6622 SECURITY BLVD
Second Line :
City : BALTIMORE
State : MD
Zip : 21207-4010
Country : US
Telephone Number : 410-944-6611
Fax Number : 410-944-0236
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2014
Last Update Date : 06/25/2014

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Directions to “ ALDA FANSI NGASSA PHARMD” Practice Location

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