Active NPI
Derek Fomba
- Pharmacist
- Hyattsville, MD
National Provider Identifier
1952710220
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 19842
- Practice address
- 7401 Annapolis Rd
Hyattsville, MD 20784-2313 - Phone
- (301) 577-7282
- Fax
- (301) 577-5024
- NPI assigned
- Aug 11, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 19842 | MD | Primary |
Addresses
Primary practice location
7401 Annapolis Rd
Hyattsville, MD 20784-2313
Mailing address
7401 Annapolis Rd
Hyattsville, MD 20784-2313
Phone (301) 577-7282
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19842 | MD | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Maryland CVS Pharmacy, L.L.C. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pharmacy
- Gaithersburg, MD
- NPI 1669100285
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1407715200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1407715200000",
"number": "1952710220",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7401 ANNAPOLIS RD",
"city": "HYATTSVILLE",
"state": "MD",
"postal_code": "207842313",
"telephone_number": "301-577-7282",
"fax_number": "301-577-5024"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7401 ANNAPOLIS RD",
"city": "HYATTSVILLE",
"state": "MD",
"postal_code": "207842313",
"telephone_number": "301-577-7282",
"fax_number": "301-577-5024"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FOMBA",
"first_name": "DEREK",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-08-11",
"last_updated": "2014-08-11",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MD",
"license": "19842",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hyattsville, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.