Provider Demographics
NPI:1073808556
Name:NGONDARA, ANTONY (PHARMD)
Entity Type:Individual
Prefix:
First Name:ANTONY
Middle Name:
Last Name:NGONDARA
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 1:2255 S EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-6318
Mailing Address - Country:US
Mailing Address - Phone:760-828-0001
Mailing Address - Fax:
Practice Address - Street 1:2255 S EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-6318
Practice Address - Country:US
Practice Address - Phone:760-828-0001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61834183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist