Healthcare Provider Details

I. General information

NPI: 1437800265
Provider Name (Legal Business Name): IVY NWOGU PHARMD, BCPS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2022
Last Update Date: 01/13/2022
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 N CHURCH ST
GREENSBORO NC
27401-1007
US

IV. Provider business mailing address

1014 GRAYS LAND CT APT 824
KERNERSVILLE NC
27284-0056
US

V. Phone/Fax

Practice location:
  • Phone: 336-832-7462
  • Fax:
Mailing address:
  • Phone: 832-623-1514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number29856
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: