=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235845488
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHUKWUNONSO NWANDU PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2023
-----------------------------------------------------
Last Update Date | 01/30/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 LIBERTY ST
-----------------------------------------------------
City | WALKERTON
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46574-1246
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-586-7154
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 26117 S COUNTYFAIR DR
-----------------------------------------------------
City | MONEE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60449-8783
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 26030158A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------