Provider Demographics
NPI:1518590967
Name:NWANNA, NWANDO (PHARMD)
Entity type:Individual
Prefix:DR
First Name:NWANDO
Middle Name:
Last Name:NWANNA
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 1:3637 CHATHAM DR
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-4711
Mailing Address - Country:US
Mailing Address - Phone:727-403-0754
Mailing Address - Fax:
Practice Address - Street 1:1153 MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-5332
Practice Address - Country:US
Practice Address - Phone:727-953-9880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-13
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS33572183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist