Healthcare Provider Details

I. General information

NPI: 1467744565
Provider Name (Legal Business Name): EZE WOKOCHA PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2011
Last Update Date: 05/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 ROWAN ST
FAYETTEVILLE NC
28301-4920
US

IV. Provider business mailing address

3440 TORRINGTON WAY APT 3
FAYETTEVILLE NC
28314-2665
US

V. Phone/Fax

Practice location:
  • Phone: 910-307-0342
  • Fax:
Mailing address:
  • Phone: 609-674-1360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number20073
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: