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General NPI Number Information
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NPI Number | 1396525713
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Entity Type | Individual
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Provider Name | AJONGAKO ATABONG
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Gender | Female
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Dates
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Enumeration Date | 10/03/2023
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Last Update Date | 10/03/2023
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Provider Practice Location Address
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Address Line | 134 W BROAD ST
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City | FALLS CHURCH
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State | VA
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Zip | 22046-4201
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Country | US
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Telephone | 703-538-4835
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Fax |
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Provider Business Mailing Address
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Address Line | 775 GATEWAY DR SE APT 315
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City | LEESBURG
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State | VA
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Zip | 20175-4037
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 0202221538
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License Number State | VA
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