Provider Demographics
NPI:1083304323
Name:NYANTAKYI, BIANCA
Entity Type:Individual
Prefix:DR
First Name:BIANCA
Middle Name:
Last Name:NYANTAKYI
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 1:14305 REVELRY BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-5500
Mailing Address - Country:US
Mailing Address - Phone:703-677-4969
Mailing Address - Fax:
Practice Address - Street 1:14305 REVELRY BLVD
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-5500
Practice Address - Country:US
Practice Address - Phone:703-677-4969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202216183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist