Healthcare Provider Details

I. General information

NPI: 1306531454
Provider Name (Legal Business Name): SHERIFF LAMIN BANGURA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2023
Last Update Date: 04/05/2023
Certification Date: 04/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 WOODMAN DR
BEAVERCREEK OH
45431-1423
US

IV. Provider business mailing address

146 WOODMAN DR
BEAVERCREEK OH
45431-1423
US

V. Phone/Fax

Practice location:
  • Phone: 937-256-1901
  • Fax:
Mailing address:
  • Phone: 857-352-9562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03442478
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: