Healthcare Provider Details

I. General information

NPI: 1376450544
Provider Name (Legal Business Name): EZINNE NWOSU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

585 YONKERS AVE
YONKERS NY
10704-2683
US

IV. Provider business mailing address

123 HILLCREST AVE
YONKERS NY
10705-1511
US

V. Phone/Fax

Practice location:
  • Phone: 914-423-5964
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number073129
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: