Provider Demographics
NPI:1124612676
Name:DIOUF, AGNES
Entity type:Individual
Prefix:
First Name:AGNES
Middle Name:
Last Name:DIOUF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7501 BALTIMORE AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20740-3651
Mailing Address - Country:US
Mailing Address - Phone:301-955-1922
Mailing Address - Fax:301-955-1932
Practice Address - Street 1:7501 BALTIMORE AVE STE 1
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20740-3651
Practice Address - Country:US
Practice Address - Phone:301-955-1922
Practice Address - Fax:301-955-1932
Is Sole Proprietor?:No
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD175351835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist