Provider Demographics
NPI:1932070018
Name:ETONGWE, BECKY DIALE
Entity type:Individual
Prefix:MS
First Name:BECKY
Middle Name:DIALE
Last Name:ETONGWE
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 1:3793 GUESS RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-6910
Mailing Address - Country:US
Mailing Address - Phone:919-479-5156
Mailing Address - Fax:919-479-5670
Practice Address - Street 1:3793 GUESS RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-6910
Practice Address - Country:US
Practice Address - Phone:919-479-5156
Practice Address - Fax:919-479-5670
Is Sole Proprietor?:No
Enumeration Date:2025-09-13
Last Update Date:2025-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC34179183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist