Provider Demographics
NPI:1104426782
Name:NDIVA MONGOH, NALOVA (RPH)
Entity type:Individual
Prefix:DR
First Name:NALOVA
Middle Name:
Last Name:NDIVA MONGOH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7040 MIRAMAR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75054-5562
Mailing Address - Country:US
Mailing Address - Phone:832-715-5360
Mailing Address - Fax:
Practice Address - Street 1:2121 N COLLINS ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-2878
Practice Address - Country:US
Practice Address - Phone:817-505-1389
Practice Address - Fax:817-505-1390
Is Sole Proprietor?:No
Enumeration Date:2020-10-31
Last Update Date:2020-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61573183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist