Provider Demographics
NPI:1275717381
Name:MADAMBI, NGONIDZASHE (RPH)
Entity Type:Individual
Prefix:
First Name:NGONIDZASHE
Middle Name:
Last Name:MADAMBI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14209-1111
Mailing Address - Country:US
Mailing Address - Phone:905-321-2802
Mailing Address - Fax:
Practice Address - Street 1:1410 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209-1111
Practice Address - Country:US
Practice Address - Phone:905-321-2802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-26
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000161183500000X
MI5302035079183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist