Provider Demographics
NPI:1548859713
Name:NTIEGE KANG, NTIEGE (PHARMACIST)
Entity type:Individual
Prefix:
First Name:NTIEGE
Middle Name:
Last Name:NTIEGE KANG
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6529 LANDOVER RD APT 303
Mailing Address - Street 2:
Mailing Address - City:CHEVERLY
Mailing Address - State:MD
Mailing Address - Zip Code:20785-1429
Mailing Address - Country:US
Mailing Address - Phone:302-399-9749
Mailing Address - Fax:
Practice Address - Street 1:9200 BALTIMORE NATIONAL PIKE
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-2613
Practice Address - Country:US
Practice Address - Phone:410-461-3120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist