Healthcare Provider Details

I. General information

NPI: 1336447978
Provider Name (Legal Business Name): EMMANUEL NDUBUEZE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2011
Last Update Date: 03/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5210 OAKLAWN BLVD
HOPEWELL VA
23860-7336
US

IV. Provider business mailing address

14467 WOODLEIGH DR
CHESTER VA
23831-6574
US

V. Phone/Fax

Practice location:
  • Phone: 804-458-8688
  • Fax: 804-458-1803
Mailing address:
  • Phone: 804-796-1034
  • Fax: 804-318-1870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202009523
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: