=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336451053
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NENE P OKWUJE RPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/10/2010
-----------------------------------------------------
Last Update Date | 07/10/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11340 CRENSHAW BLVD RITE AID
-----------------------------------------------------
City | INGLEWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-757-2811
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1612 W 218TH ST UNIT D
-----------------------------------------------------
City | TORRANCE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90501-7800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-414-7539
-----------------------------------------------------
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 | 47929
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------