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NPI Code Detail

MEDICARE: DR. NNEDI EZENWA DPH

MEDICARE: DR. NNEDI EZENWA DPH
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
1183500000XPharmacist12304OK

General Provider Information

NPI Number : 1841440625
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NNEDI EZENWA DPH
Provider Business Mailing Address
First Line : 5046 S SHERIDAN RD
Second Line :
City : TULSA
State : OK
Zip : 74145-5714
Country : US
Telephone Number : 918-627-6464
Fax Number : 918-627-4118
Provider Business Practice Location Address
First Line : 5046 S SHERIDAN RD
Second Line :
City : TULSA
State : OK
Zip : 74145-5714
Country : US
Telephone Number : 918-627-6464
Fax Number : 918-627-4118
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/29/2008
Last Update Date : 09/29/2008

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