Provider Demographics
NPI:1447851225
Name:NDIFON, BLANCHE (PHARMD)
Entity type:Individual
Prefix:
First Name:BLANCHE
Middle Name:
Last Name:NDIFON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11655 BRIAR FOREST DR APT 100
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-5034
Mailing Address - Country:US
Mailing Address - Phone:408-784-8707
Mailing Address - Fax:
Practice Address - Street 1:203 US LOOP, HWY 290 E
Practice Address - Street 2:
Practice Address - City:BREHNAM
Practice Address - State:TX
Practice Address - Zip Code:77833-7783
Practice Address - Country:US
Practice Address - Phone:408-784-8707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66660183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist