Provider Demographics
NPI:1154011393
Name:MO, JIANCHENG (PHARMD)
Entity type:Individual
Prefix:
First Name:JIANCHENG
Middle Name:
Last Name:MO
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 1:9635 WHITEACRE RD UNIT C2
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-3556
Mailing Address - Country:US
Mailing Address - Phone:617-888-1181
Mailing Address - Fax:
Practice Address - Street 1:6340 YORK RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-2320
Practice Address - Country:US
Practice Address - Phone:410-337-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD29135183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist