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NPI Code Detail

MEDICARE: DR. WINNIE LAILA KALUUMA NANSAMBA PHARMD

MEDICARE: DR. WINNIE LAILA KALUUMA NANSAMBA 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
1183500000XPharmacist49367TX

General Provider Information

NPI Number : 1659654325
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. WINNIE LAILA KALUUMA NANSAMBA PHARMD
Provider Business Mailing Address
First Line : 3809 E BELKNAP ST
Second Line :
City : FORT WORTH
State : TX
Zip : 76111-6013
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3809 E BELKNAP ST
Second Line :
City : FORT WORTH
State : TX
Zip : 76111-6013
Country : US
Telephone Number : 817-834-7283
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2011
Last Update Date : 09/20/2011

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