Provider Demographics
NPI:1457780355
Name:AGYAPONG, SANDRA (PHARM D)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:AGYAPONG
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 1:1310 LIRIOPE CT APT 202
Mailing Address - Street 2:
Mailing Address - City:BELCAMP
Mailing Address - State:MD
Mailing Address - Zip Code:21017-2644
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:208 PLUMTREE RD STE A
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-6056
Practice Address - Country:US
Practice Address - Phone:410-670-3719
Practice Address - Fax:410-670-3751
Is Sole Proprietor?:No
Enumeration Date:2013-11-01
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21761183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist