Provider Demographics
NPI:1548642424
Name:NWANKWO, VIVIAN (PHARMACIST)
Entity type:Individual
Prefix:MRS
First Name:VIVIAN
Middle Name:
Last Name:NWANKWO
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2710 NOGALITOS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78225-1750
Mailing Address - Country:US
Mailing Address - Phone:210-533-7773
Mailing Address - Fax:
Practice Address - Street 1:2710 NOGALITOS
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78225-1750
Practice Address - Country:US
Practice Address - Phone:210-533-7773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-26
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX56380183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist