MEDICARE: DR. CYNTHIA KEMAYOU NGONGA PHARM D

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	PD11377	AR
2	183500000X	Pharmacist	48374	TX

General Provider Information

NPI Number	:	1578857769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CYNTHIA KEMAYOU NGONGA PHARM D

Provider Business Mailing Address
First Line	:	4001 PHOENIX AVE
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-6099
Country	:	US
Telephone Number	:	479-709-8941
Fax Number	:	479-709-8951

Provider Business Practice Location Address
First Line	:	4001 PHOENIX AVE
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-6099
Country	:	US
Telephone Number	:	479-709-8941
Fax Number	:	479-709-8951

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

Provider Enumeration Date	:	06/05/2011
Last Update Date	:	06/05/2011

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