Provider Demographics
NPI:1003428376
Name:SENYONGA, MATIA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MATIA
Middle Name:
Last Name:SENYONGA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5206 W GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031-2202
Mailing Address - Country:US
Mailing Address - Phone:315-468-1701
Mailing Address - Fax:315-468-1837
Practice Address - Street 1:5206 W GENESEE ST
Practice Address - Street 2:
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031-2202
Practice Address - Country:US
Practice Address - Phone:315-468-1701
Practice Address - Fax:315-468-1837
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY066288-01183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist