Healthcare Provider Details

I. General information

NPI: 1487915138
Provider Name (Legal Business Name): WANKA NDIFOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2012
Last Update Date: 05/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5255 LOUGHBORO RD NW
WASHINGTON DC
20016-2633
US

IV. Provider business mailing address

9116 SCOTT ADAM CT 201
LAUREL MD
20708-1044
US

V. Phone/Fax

Practice location:
  • Phone: 202-537-4171
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH10000094
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: