Provider Demographics
NPI:1992453708
Name:NWADOR, IJEOMA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:IJEOMA
Middle Name:
Last Name:NWADOR
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 1/2 BASS PL SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-6364
Mailing Address - Country:US
Mailing Address - Phone:973-573-2202
Mailing Address - Fax:
Practice Address - Street 1:3713 LEE HWY
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22207-3720
Practice Address - Country:US
Practice Address - Phone:703-841-2432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-11
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202211146183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0202211146OtherVIRGINIA BOARD OF PHARMACY LICENSE