Provider Demographics
NPI:1538395439
Name:MENGANG, GERARD ME-NSOPE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:GERARD
Middle Name:ME-NSOPE
Last Name:MENGANG
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 W LOCUST ST
Mailing Address - Street 2:UNIT 24F
Mailing Address - City:SEAFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19973-2300
Mailing Address - Country:US
Mailing Address - Phone:302-536-1484
Mailing Address - Fax:302-628-6108
Practice Address - Street 1:22898 SUSSEX HWY
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:DE
Practice Address - Zip Code:19973-5852
Practice Address - Country:US
Practice Address - Phone:302-628-6100
Practice Address - Fax:302-628-6106
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-05
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0003843183500000X
MD19140183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD19140OtherMARYLAND STATE BOARD OF PHARMACY
DEA1-0003843OtherDELAWARE STATE BOARD OF PROFESSIONAL REGULATIONS/PHARMACY