Provider Demographics
NPI:1861614695
Name:NWOSU, IFEYINWA E (RPH)
Entity type:Individual
Prefix:MRS
First Name:IFEYINWA
Middle Name:E
Last Name:NWOSU
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 E REDD RD
Mailing Address - Street 2:BLDG # 1A
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-7264
Mailing Address - Country:US
Mailing Address - Phone:915-845-7600
Mailing Address - Fax:915-845-7601
Practice Address - Street 1:840 E REDD RD
Practice Address - Street 2:BLDG # 1A
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-7264
Practice Address - Country:US
Practice Address - Phone:915-845-7600
Practice Address - Fax:915-845-7601
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39116183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145802Medicaid
TX5577830002Medicare NSC