Provider Demographics
NPI:1871964304
Name:MOMANYI, LILIAN NYANGANYI (PHARMD)
Entity type:Individual
Prefix:
First Name:LILIAN
Middle Name:NYANGANYI
Last Name:MOMANYI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:LILIAN
Other - Middle Name:NYANGANYI
Other - Last Name:OENGA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:4303 CRESTVIEW LN
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-8623
Mailing Address - Country:US
Mailing Address - Phone:817-301-4590
Mailing Address - Fax:
Practice Address - Street 1:4303 CRESTVIEW LN
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-8623
Practice Address - Country:US
Practice Address - Phone:817-301-4590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-09
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX43436183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist