Provider Demographics
NPI:1952904013
Name:MBANYA, HERVE GILLES
Entity Type:Individual
Prefix:DR
First Name:HERVE
Middle Name:GILLES
Last Name:MBANYA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 WINDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-8570
Mailing Address - Country:US
Mailing Address - Phone:832-654-2125
Mailing Address - Fax:
Practice Address - Street 1:10401 ANDERSON MILL RD STE 112B
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-2579
Practice Address - Country:US
Practice Address - Phone:512-270-4899
Practice Address - Fax:512-237-7360
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50438183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist