Provider Demographics
NPI:1245756899
Name:FERNANDES, BRONESSA S (PHARM D)
Entity type:Individual
Prefix:
First Name:BRONESSA
Middle Name:S
Last Name:FERNANDES
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18317 QUONDAL CT
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-3863
Mailing Address - Country:US
Mailing Address - Phone:240-422-4999
Mailing Address - Fax:
Practice Address - Street 1:14101 DARNESTOWN RD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-3009
Practice Address - Country:US
Practice Address - Phone:240-631-9629
Practice Address - Fax:240-631-9724
Is Sole Proprietor?:No
Enumeration Date:2017-08-16
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23378183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist