Healthcare Provider Details

I. General information

NPI: 1104090224
Provider Name (Legal Business Name): UCHECHUKWU AZUKA NWOBODO PHARM.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2008
Last Update Date: 04/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

543 S 52ND STREET
PHILADELPHIA PA
19143-3240
US

IV. Provider business mailing address

543 S. 52ND STREET
PHILADELPHIA PA
19143-1410
US

V. Phone/Fax

Practice location:
  • Phone: 215-476-1724
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP439822
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: