Provider Demographics
NPI:1053856211
Name:BANURA, ANNET
Entity Type:Individual
Prefix:
First Name:ANNET
Middle Name:
Last Name:BANURA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19100 MONTGOMERY VILLAGE AVE
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY VILLAGE
Mailing Address - State:MD
Mailing Address - Zip Code:20886-3701
Mailing Address - Country:US
Mailing Address - Phone:301-948-6886
Mailing Address - Fax:
Practice Address - Street 1:19100 MONTGOMERY VILLAGE AVE
Practice Address - Street 2:
Practice Address - City:MONTGOMERY VILLAGE
Practice Address - State:MD
Practice Address - Zip Code:20886-3701
Practice Address - Country:US
Practice Address - Phone:301-948-6886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-27
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16993183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist