Provider Demographics
NPI:1134418858
Name:AGUNANNE, GLORIA CHINENYE (RPH)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:CHINENYE
Last Name:AGUNANNE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:GLORIA
Other - Middle Name:CHINENYE
Other - Last Name:ONYEADOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:2212 ARIANO LN
Mailing Address - Street 2:
Mailing Address - City:CERES
Mailing Address - State:CA
Mailing Address - Zip Code:95307-7152
Mailing Address - Country:US
Mailing Address - Phone:209-538-2417
Mailing Address - Fax:
Practice Address - Street 1:3900 PELANDALE AVE STE 500A
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-9104
Practice Address - Country:US
Practice Address - Phone:209-545-0766
Practice Address - Fax:209-545-0611
Is Sole Proprietor?:No
Enumeration Date:2011-04-04
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50709183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist