Organization
BANVERA LLC
Active
Other names
Medicap Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
BANYO NDANGA RPH (OWNER PHARMACIST)
(757) 599-9643
Entity
Organization
Contact information
Practice address
956 J CLYDE MORRIS BLVD, NEWPORT NEWS, VA 23601-1043
(757) 599-9643
(757) 599-9647
Mailing address
956 J CLYDE MORRIS BLVD, NEWPORT NEWS, VA 23601-1043
(757) 599-9643
(757) 599-9647
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
VA
3336C0003X
Community/Retail Pharmacy
Primary
0201004165
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010262615
—
VA
01
—
4840078
NCPDP#
VA
Enumeration date
06/04/2007
Last updated
07/19/2024
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