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NPI Code Detail

MEDICARE: DR. CHIBUGO EJISOBY-NWOSU

MEDICARE: DR. CHIBUGO EJISOBY-NWOSU
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
11835P2201XAmbulatory Care Pharmacist019518GA
21835P0018XPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist019518GA

General Provider Information

NPI Number : 1265952329
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHIBUGO EJISOBY-NWOSU
Provider Business Mailing Address
First Line : 1284 GLANDOR CT SE
Second Line :
City : MABLETON
State : GA
Zip : 30126-2755
Country : US
Telephone Number : 678-230-3089
Fax Number :
Provider Business Practice Location Address
First Line : 2994 ATLANTA RD SE
Second Line :
City : SMYRNA
State : GA
Zip : 30080-3655
Country : US
Telephone Number : 770-435-2178
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2017
Last Update Date : 06/21/2017

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