MEDICARE: SERGE TIYONG IFOUE 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
1	183500000X	Pharmacist	25365	MD
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1821500257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SERGE TIYONG IFOUE PHARMD

Provider Business Mailing Address
First Line	:	1100 LETCHWORTH CT
Second Line	:
City	:	ABINGDON
State	:	MD
Zip	:	21009-1102
Country	:	US
Telephone Number	:	443-622-6597
Fax Number	:

Provider Business Practice Location Address
First Line	:	1520 ROCK SPRING RD
Second Line	:
City	:	FOREST HILL
State	:	MD
Zip	:	21050-2815
Country	:	US
Telephone Number	:	410-836-5288
Fax Number	:

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

Provider Enumeration Date	:	10/25/2017
Last Update Date	:	10/25/2024

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