Healthcare Provider Details

I. General information

NPI: 1174129290
Provider Name (Legal Business Name): MRS. CHIOMA UWAKOLAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2020
Last Update Date: 12/05/2020
Certification Date: 12/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 KENNEDY ST NW
WASHINGTON DC
20011-5213
US

IV. Provider business mailing address

128 KENNEDY ST NW
WASHINGTON DC
20011-5213
US

V. Phone/Fax

Practice location:
  • Phone: 202-829-3235
  • Fax: 202-829-1663
Mailing address:
  • Phone: 202-829-3235
  • Fax: 202-829-1663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH100001960
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: