Basic Information
| Provider Information | |||||||||
| NPI: | 1275153645 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BANNING | ||||||||
| FirstName: | AWURADJOA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17 PETER AVE | ||||||||
| Address2: | |||||||||
| City: | KENDALL PARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088241650 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7323208030 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 321 N WARREN ST | ||||||||
| Address2: | |||||||||
| City: | TRENTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 086184741 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6092785931 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2020 | ||||||||
| LastUpdateDate: | 04/25/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/25/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336C0003X | NJ | Y | Suppliers | Pharmacy | Community/Retail Pharmacy |
No ID Information.