Healthcare Provider Details

I. General information

NPI: 1528286069
Provider Name (Legal Business Name): MS. BANYO MAKIA NDANGA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2007
Last Update Date: 07/19/2024
Certification Date: 07/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

671 J CLYDE MORRIS BLVD
NEWPORT NEWS VA
23601-1839
US

IV. Provider business mailing address

804 MARLBANK DR
YORKTOWN VA
23692-4352
US

V. Phone/Fax

Practice location:
  • Phone: 757-596-0037
  • Fax: 757-595-5729
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202-009974
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: