Individual
RENE COSME SOH FONGANG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1230 BAY DALE DR, ARNOLD, MD 21012-2325
(410) 757-0027
Mailing address
19821 APPLE RIDGE PL, MONTGOMERY VILLAGE, MD 20886-1039
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
25167
MD
Other
Enumeration date
10/05/2017
Last updated
10/05/2017
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