Provider Demographics
NPI:1548942873
Name:ALANA, FUNMILOLA
Entity type:Individual
Prefix:
First Name:FUNMILOLA
Middle Name:
Last Name:ALANA
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 1:114 GOVERNORS CT APT C
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-3198
Mailing Address - Country:US
Mailing Address - Phone:443-878-9713
Mailing Address - Fax:
Practice Address - Street 1:5101 DUKE ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-2905
Practice Address - Country:US
Practice Address - Phone:703-823-7430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202221345183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist