Provider Demographics
NPI:1073087698
Name:NWANA, NADERGE (RPH)
Entity Type:Individual
Prefix:DR
First Name:NADERGE
Middle Name:
Last Name:NWANA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 NORTHWEST DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-1434
Mailing Address - Country:US
Mailing Address - Phone:301-232-6407
Mailing Address - Fax:
Practice Address - Street 1:2023 LYCOMING CREEK RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-1206
Practice Address - Country:US
Practice Address - Phone:570-327-9920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-16
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP453064183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist