MEDICARE: SANDRA NZOUNKWELLE 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	27798	MD

General Provider Information

NPI Number	:	1861974818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA NZOUNKWELLE PHARMD

Provider Business Mailing Address
First Line	:	14918 4TH ST
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20707-3702
Country	:	US
Telephone Number	:	240-838-1285
Fax Number	:

Provider Business Practice Location Address
First Line	:	6918 WILLOW ST NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20012-2197
Country	:	US
Telephone Number	:	301-523-6406
Fax Number	:

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

Provider Enumeration Date	:	09/05/2018
Last Update Date	:	11/30/2022

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