Provider Demographics
NPI:1063063337
Name:KWIGOUA, RITA TATIANA LEWE
Entity type:Individual
Prefix:
First Name:RITA TATIANA
Middle Name:LEWE
Last Name:KWIGOUA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 W PHILADELPHIA ST APT 3E
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17401-5325
Mailing Address - Country:US
Mailing Address - Phone:301-640-8066
Mailing Address - Fax:
Practice Address - Street 1:3300 E MARKET ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-2619
Practice Address - Country:US
Practice Address - Phone:717-840-0204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP453915183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist