Provider Demographics
NPI:1356624936
Name:NWABUEZE, CHISOMU OGEDELU (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CHISOMU
Middle Name:OGEDELU
Last Name:NWABUEZE
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 1:800 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01832-3612
Mailing Address - Country:US
Mailing Address - Phone:978-521-0618
Mailing Address - Fax:978-521-0927
Practice Address - Street 1:800 RIVER ST
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01832-3612
Practice Address - Country:US
Practice Address - Phone:978-521-0618
Practice Address - Fax:978-521-0927
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH26425183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0404888Medicaid