Healthcare Provider Details

I. General information

NPI: 1922902030
Provider Name (Legal Business Name): NDUTA NJUBI
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CVS DR
WOONSOCKET RI
02895-6146
US

IV. Provider business mailing address

1 NILES ST
WORCESTER MA
01604-2601
US

V. Phone/Fax

Practice location:
  • Phone: 774-712-5018
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH1002862
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: