Provider Demographics
NPI:1528471018
Name:FANNY, FATOUMATA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:FATOUMATA
Middle Name:
Last Name:FANNY
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 1:1334 CRAIN HWY
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-1802
Mailing Address - Country:US
Mailing Address - Phone:301-249-6575
Mailing Address - Fax:301-249-9259
Practice Address - Street 1:1334 CRAIN HWY
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-1802
Practice Address - Country:US
Practice Address - Phone:301-249-6575
Practice Address - Fax:301-249-9259
Is Sole Proprietor?:No
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17619183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist