MEDICARE: ETIM NKEREUWEM

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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	RPH034558	GA

General Provider Information

NPI Number	:	1275311177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ETIM NKEREUWEM

Provider Business Mailing Address
First Line	:	1475 BUFORD DR
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30043-3719
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1475 BUFORD DR
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30043-3719
Country	:	US
Telephone Number	:	770-822-6595
Fax Number	:

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

Provider Enumeration Date	:	09/20/2023
Last Update Date	:	09/20/2023

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Directions to “ ETIM NKEREUWEM ” Practice Location

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