Healthcare Provider Details

I. General information

NPI: 1962168153
Provider Name (Legal Business Name): WISDOM TWUMHENE PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2021
Last Update Date: 12/15/2021
Certification Date: 12/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1137 EMMET ST N
CHARLOTTESVILLE VA
22903-4837
US

IV. Provider business mailing address

203 W G ST
ONTARIO CA
91762-3227
US

V. Phone/Fax

Practice location:
  • Phone: 202-372-6644
  • Fax:
Mailing address:
  • Phone: 202-372-6644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202220068
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: