Provider Demographics
NPI:1538717780
Name:NWANZE, DONALD O (PHARMD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:O
Last Name:NWANZE
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:PO BOX 721
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:CA
Mailing Address - Zip Code:90702-0721
Mailing Address - Country:US
Mailing Address - Phone:310-704-5160
Mailing Address - Fax:
Practice Address - Street 1:MLK OUTPATIENT CENTER (PHARMACY)
Practice Address - Street 2:1670 EAST 120TH STREET
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90059
Practice Address - Country:US
Practice Address - Phone:424-338-1965
Practice Address - Fax:310-223-5997
Is Sole Proprietor?:No
Enumeration Date:2019-08-30
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56287183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist