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General NPI Number Information
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NPI Number | 1447851225
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Entity Type | Individual
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Provider Name | BLANCHE NDIFON PHARMD
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Gender | Female
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Dates
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Enumeration Date | 11/06/2020
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Last Update Date | 11/06/2020
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Provider Practice Location Address
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Address Line | 203 US LOOP, HWY 290 E
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City | BREHNAM
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State | TX
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Zip | 77833-7783
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Country | US
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Telephone | 408-784-8707
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Fax |
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Provider Business Mailing Address
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Address Line | 11655 BRIAR FOREST DR APT 100
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City | HOUSTON
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State | TX
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Zip | 77077-5034
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Country | US
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Telephone | 408-784-8707
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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 | 66660
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License Number State | TX
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