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General NPI Number Information
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NPI Number | 1114584596
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Entity Type | Individual
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Provider Name | JOSEPHINE ADAEZE NWISU
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Gender | Female
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Dates
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Enumeration Date | 05/21/2019
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Last Update Date | 05/21/2019
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Provider Practice Location Address
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Address Line | 616 E HOBSONWAY
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City | BLYTHE
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State | CA
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Zip | 92225-1739
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Country | US
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Telephone | 760-922-9867
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Fax |
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Provider Business Mailing Address
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Address Line | 151 N ASH AVE
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City | BLYTHE
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State | CA
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Zip | 92225-1501
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Country | US
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Telephone | 760-922-5029
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH80104
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License Number State | CA
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