Provider Demographics
NPI:1053012906
Name:KWONG, MANDY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MANDY
Middle Name:
Last Name:KWONG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9318 GAITHER RD STE 205
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-1409
Mailing Address - Country:US
Mailing Address - Phone:240-393-5950
Mailing Address - Fax:
Practice Address - Street 1:9318 GAITHER RD STE 205
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-1409
Practice Address - Country:US
Practice Address - Phone:240-393-5950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15805183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist