MEDICARE: HELMOND LOBGA GWANYAMA PHARMACIST

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	20079	OK

General Provider Information

NPI Number	:	1912782558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HELMOND LOBGA GWANYAMA PHARMACIST

Provider Business Mailing Address
First Line	:	8317 NW 105TH TER
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73162-4028
Country	:	US
Telephone Number	:	405-476-4622
Fax Number	:

Provider Business Practice Location Address
First Line	:	8317 NW 105TH TER
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73162-4028
Country	:	US
Telephone Number	:	405-476-4622
Fax Number	:

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

Provider Enumeration Date	:	08/30/2023
Last Update Date	:	08/30/2023

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