Provider Demographics
NPI:1679357289
Name:NWOGA, CHITUO
Entity type:Individual
Prefix:
First Name:CHITUO
Middle Name:
Last Name:NWOGA
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 1:1222 RILEY PRESERVE CT
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:VA
Mailing Address - Zip Code:22066-2314
Mailing Address - Country:US
Mailing Address - Phone:202-203-8575
Mailing Address - Fax:
Practice Address - Street 1:11670 PLAZA AMERICA DR
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-4700
Practice Address - Country:US
Practice Address - Phone:703-481-5722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202207004183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist