Individual provider Active NPI

Mandop Marilyn Fonkeng

  • Pharmacist
  • Silver Spring, MD
National Provider Identifier
1902303571
Registry record updated Apr 10, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
25483 Issued in MD
Practice address
1290 E West Hwy
Silver Spring, MD 20910-3242
Phone
(301) 588-6261
NPI assigned
Apr 10, 2018
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 10, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 25483 MD Primary

Addresses

Primary practice location

1290 E West Hwy
Silver Spring, MD 20910-3242

Mailing address

1103 Burketon Rd
Hyattsville, MD 20783-3002
Phone (678) 346-1149

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1523318400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1523318400000",
    "number": "1902303571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1103 BURKETON RD",
            "city": "HYATTSVILLE",
            "state": "MD",
            "postal_code": "207833002",
            "telephone_number": "678-346-1149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1290 E WEST HWY",
            "city": "SILVER SPRING",
            "state": "MD",
            "postal_code": "209103242",
            "telephone_number": "301-588-6261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FONKENG",
        "first_name": "MANDOP",
        "middle_name": "MARILYN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-04-10",
        "last_updated": "2018-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MD",
            "license": "25483",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Silver Spring, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.