MEDICARE: GLORY ANANGAFAC NGIMAJU

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	03441251	OH

General Provider Information

NPI Number	:	1710659511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLORY ANANGAFAC NGIMAJU

Provider Business Mailing Address
First Line	:	4217 STILMORE RD
Second Line	:
City	:	SOUTH EUCLID
State	:	OH
Zip	:	44121-3131
Country	:	US
Telephone Number	:	703-935-9513
Fax Number	:

Provider Business Practice Location Address
First Line	:	10502 SAINT CLAIR AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44108-1955
Country	:	US
Telephone Number	:	216-451-9027
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2021
Last Update Date	:	09/30/2021

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