MEDICARE: JOSEPHINE ADAEZE NWISU

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RPH80104	CA

General Provider Information

NPI Number	:	1114584596
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPHINE ADAEZE NWISU

Provider Business Mailing Address
First Line	:	151 N ASH AVE
Second Line	:
City	:	BLYTHE
State	:	CA
Zip	:	92225-1501
Country	:	US
Telephone Number	:	760-922-5029
Fax Number	:

Provider Business Practice Location Address
First Line	:	616 E HOBSONWAY
Second Line	:
City	:	BLYTHE
State	:	CA
Zip	:	92225-1739
Country	:	US
Telephone Number	:	760-922-9867
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2019
Last Update Date	:	05/21/2019

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Directions to “ JOSEPHINE ADAEZE NWISU ” Practice Location

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