MEDICARE: ABIEMWENSE IYAMU

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	RP453566	PA

General Provider Information

NPI Number	:	1952956344
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABIEMWENSE IYAMU

Provider Business Mailing Address
First Line	:	1334 WINDRIM AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19141-2725
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1334 WINDRIM AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19141-2725
Country	:	US
Telephone Number	:	862-215-5133
Fax Number	:

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

Provider Enumeration Date	:	08/03/2019
Last Update Date	:	08/03/2019

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Directions to “ ABIEMWENSE IYAMU ” Practice Location

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