Healthcare Provider Details

I. General information

NPI: 1235742875
Provider Name (Legal Business Name): JOSEPH IJEOMAH NNANI PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2020
Last Update Date: 08/30/2021
Certification Date: 08/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

US HIGHWAY 491 NORTH
SHIPROCK NM
87420-1816
US

IV. Provider business mailing address

300 E 18TH ST APT 1
FARMINGTON NM
87401-6313
US

V. Phone/Fax

Practice location:
  • Phone: 505-368-7265
  • Fax:
Mailing address:
  • Phone: 682-472-4210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS024818
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: