MEDICARE: DR. WANDA MERCY AZU OWOH PHARMD

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	RP452158	PA

General Provider Information

NPI Number	:	1134635329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WANDA MERCY AZU OWOH PHARMD

Provider Business Mailing Address
First Line	:	4055 RIDGE AVE APT 5510
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19129-1589
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1617 JOHN F KENNEDY BLVD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-1821
Country	:	US
Telephone Number	:	215-561-1316
Fax Number	:

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

Provider Enumeration Date	:	12/25/2017
Last Update Date	:	12/25/2017

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