MEDICARE: MR. OGOCHUKWU N EZUMBA

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	5302048478	MI
2	183500000X	Pharmacist	21263-40	WI

General Provider Information

NPI Number	:	1982460523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. OGOCHUKWU N EZUMBA

Provider Business Mailing Address
First Line	:	2326 E MENLO BLVD
Second Line	:
City	:	SHOREWOOD
State	:	WI
Zip	:	53211-2608
Country	:	US
Telephone Number	:	141-470-8391
Fax Number	:

Provider Business Practice Location Address
First Line	:	5715 W APPLETON AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53210-2250
Country	:	US
Telephone Number	:	414-988-2188
Fax Number	:

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

Provider Enumeration Date	:	02/22/2024
Last Update Date	:	02/22/2024

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