Healthcare Provider Details

I. General information

NPI: 1255826012
Provider Name (Legal Business Name): COSMAS CHUKWUEMEKA NWEREM JR. PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2018
Last Update Date: 06/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 SW COURT PLACE
PENDLETON OR
97801
US

IV. Provider business mailing address

145 NE 92ND PL
PORTLAND OR
97220-4520
US

V. Phone/Fax

Practice location:
  • Phone: 541-276-1185
  • Fax:
Mailing address:
  • Phone: 503-329-3655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0016303
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: