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General NPI Number Information
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NPI Number | 1275123846
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Entity Type | Individual
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Provider Name | KWANTA NATHALANG WU PHARMD
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Gender | Female
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Dates
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Enumeration Date | 01/19/2021
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Last Update Date | 01/19/2021
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Provider Practice Location Address
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Address Line | 1654 E MARKET ST # 06467
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City | NAPPANEE
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State | IN
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Zip | 46550-2339
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Country | US
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Telephone | 574-773-4311
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Fax |
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Provider Business Mailing Address
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Address Line | 13021 FOUNTAIN CT
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City | GRANGER
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State | IN
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Zip | 46530-4744
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Country | US
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Telephone | 574-323-7802
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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 | 051292180
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 5302047304
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 26022731A
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License Number State | IN
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