=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437977196
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NANCY CHUKWUMEZIE PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/01/2024
-----------------------------------------------------
Last Update Date | 10/01/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1825 4TH ST RM L3113
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94143-2350
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-514-8938
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 538 BALBOA ST UNIT B
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94118-3823
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-841-0051
-----------------------------------------------------
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 | 84635
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------