Provider Demographics
NPI:1114584596
Name:NWISU, JOSEPHINE ADAEZE
Entity type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:ADAEZE
Last Name:NWISU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 N ASH AVE
Mailing Address - Street 2:
Mailing Address - City:BLYTHE
Mailing Address - State:CA
Mailing Address - Zip Code:92225-1501
Mailing Address - Country:US
Mailing Address - Phone:760-922-5029
Mailing Address - Fax:
Practice Address - Street 1:616 E HOBSONWAY
Practice Address - Street 2:
Practice Address - City:BLYTHE
Practice Address - State:CA
Practice Address - Zip Code:92225-1739
Practice Address - Country:US
Practice Address - Phone:760-922-9867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH80104183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist