MEDICARE: NDIOUGA F DIENG RPH

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	1835P1200X	Pharmacotherapy Pharmacist	12622	MD

General Provider Information

NPI Number	:	1629266648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NDIOUGA F DIENG RPH

Provider Business Mailing Address
First Line	:	9203 TWIN HILL LN
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20708-2547
Country	:	US
Telephone Number	:	443-955-1242
Fax Number	:

Provider Business Practice Location Address
First Line	:	9203 TWIN HILL LN
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20708-2547
Country	:	US
Telephone Number	:	443-955-1242
Fax Number	:

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

Provider Enumeration Date	:	10/04/2007
Last Update Date	:	10/04/2007

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