Provider Demographics
NPI:1427398759
Name:OUANG-BONILLA, GLORIA C
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:C
Last Name:OUANG-BONILLA
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 1:21 ELAM PL
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-1910
Mailing Address - Country:US
Mailing Address - Phone:716-390-4722
Mailing Address - Fax:
Practice Address - Street 1:21 ELAM PL
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-1910
Practice Address - Country:US
Practice Address - Phone:716-390-4722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-23
Last Update Date:2013-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0488261183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist