Provider Demographics
NPI:1093495202
Name:AYANGHO, NELSON NGWANA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NELSON
Middle Name:NGWANA
Last Name:AYANGHO
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 1:612 CALTHORPE LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37912-2145
Mailing Address - Country:US
Mailing Address - Phone:240-486-3863
Mailing Address - Fax:
Practice Address - Street 1:612 CALTHORPE LN
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37912-2145
Practice Address - Country:US
Practice Address - Phone:240-486-3863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-21
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202221382183500000X
TN47051183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist