Healthcare Provider Details

I. General information

NPI: 1164146254
Provider Name (Legal Business Name): NDANENG HEU PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2022
Last Update Date: 10/03/2022
Certification Date: 10/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1794 ASHLAN AVE
CLOVIS CA
93611-5190
US

IV. Provider business mailing address

1794 ASHLAN AVE
CLOVIS CA
93611-5190
US

V. Phone/Fax

Practice location:
  • Phone: 559-294-6600
  • Fax:
Mailing address:
  • Phone: 559-294-6600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number85719
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: