Provider Demographics
NPI:1962168153
Name:TWUMHENE, WISDOM (PHARMD)
Entity type:Individual
Prefix:DR
First Name:WISDOM
Middle Name:
Last Name:TWUMHENE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 W G ST
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-3227
Mailing Address - Country:US
Mailing Address - Phone:202-372-6644
Mailing Address - Fax:
Practice Address - Street 1:1137 EMMET ST N
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-4837
Practice Address - Country:US
Practice Address - Phone:202-372-6644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-11
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202220068183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist