Provider Demographics
NPI:1710659511
Name:NGIMAJU, GLORY ANANGAFAC
Entity Type:Individual
Prefix:
First Name:GLORY
Middle Name:ANANGAFAC
Last Name:NGIMAJU
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 1:4217 STILMORE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-3131
Mailing Address - Country:US
Mailing Address - Phone:703-935-9513
Mailing Address - Fax:
Practice Address - Street 1:10502 SAINT CLAIR AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44108-1955
Practice Address - Country:US
Practice Address - Phone:216-451-9027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-30
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03441251183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist