Provider Demographics
NPI:1033527429
Name:CRANDON ENYI, MILDRED
Entity Type:Individual
Prefix:
First Name:MILDRED
Middle Name:
Last Name:CRANDON ENYI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MERLYN
Other - Middle Name:
Other - Last Name:CRANDON-ENYI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:7676 NEW HAMPSHIRE AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-7512
Mailing Address - Country:US
Mailing Address - Phone:301-445-6050
Mailing Address - Fax:301-445-6056
Practice Address - Street 1:7676 NEW HAMPSHIRE AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-7512
Practice Address - Country:US
Practice Address - Phone:301-445-6050
Practice Address - Fax:301-445-6056
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14883183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist