MEDICARE: NTIEGE NTIEGE KANG PHARMACIST

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
1	183500000X	Pharmacist	27600	MD

General Provider Information

NPI Number	:	1548859713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NTIEGE NTIEGE KANG PHARMACIST

Provider Business Mailing Address
First Line	:	6529 LANDOVER RD APT 303
Second Line	:
City	:	CHEVERLY
State	:	MD
Zip	:	20785-1429
Country	:	US
Telephone Number	:	302-399-9749
Fax Number	:

Provider Business Practice Location Address
First Line	:	9200 BALTIMORE NATIONAL PIKE
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-2613
Country	:	US
Telephone Number	:	410-461-3120
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/13/2021
Last Update Date	:	01/13/2021

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