Provider Demographics
NPI:1013341247
Name:ATABONG, NITA (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:NITA
Middle Name:
Last Name:ATABONG
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:ARAGA
Other - Middle Name:NITA
Other - Last Name:ANUBONDEM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3214 SCARLET OAK TER
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-1938
Mailing Address - Country:US
Mailing Address - Phone:240-552-5165
Mailing Address - Fax:
Practice Address - Street 1:15520 ANNAPOLIS RD
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-3002
Practice Address - Country:US
Practice Address - Phone:301-809-3151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-23
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD26744183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist