Healthcare Provider Details

I. General information

NPI: 1922638972
Provider Name (Legal Business Name): MARYANNE OBIANUJU NWUDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2020
Last Update Date: 01/17/2020
Certification Date: 01/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5020 W 190TH ST
TORRANCE CA
90503-1004
US

IV. Provider business mailing address

1016 VIA FORTUNA
PALOS VERDES ESTATES CA
90274-2721
US

V. Phone/Fax

Practice location:
  • Phone: 310-370-5607
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number66474
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: