Provider Demographics
NPI:1578870028
Name:NANA, LUCY CHONANG
Entity Type:Individual
Prefix:
First Name:LUCY
Middle Name:CHONANG
Last Name:NANA
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 1:11801 MEADOWLAND DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-3580
Mailing Address - Country:US
Mailing Address - Phone:301-675-8192
Mailing Address - Fax:
Practice Address - Street 1:8934 WOODYARD RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-4241
Practice Address - Country:US
Practice Address - Phone:301-868-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-04
Last Update Date:2010-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14270183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist