Healthcare Provider Details

I. General information

NPI: 1366943367
Provider Name (Legal Business Name): CHINONYEREM E UWAKWE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2018
Last Update Date: 02/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 E NORTHFIELD RD
LIVINGSTON NJ
07039-4810
US

IV. Provider business mailing address

77 RIDGE DR
LIVINGSTON NJ
07039-3743
US

V. Phone/Fax

Practice location:
  • Phone: 973-535-0900
  • Fax: 973-535-0900
Mailing address:
  • Phone: 973-489-2089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: