Provider Demographics
NPI:1851005177
Name:MBONWO AZAFACK, VALERIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:MBONWO AZAFACK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18635 CARRIAGE WALK CIR
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-5518
Mailing Address - Country:US
Mailing Address - Phone:301-655-3837
Mailing Address - Fax:
Practice Address - Street 1:18635 CARRIAGE WALK CIR
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-5518
Practice Address - Country:US
Practice Address - Phone:301-655-3837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD147831183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist