Provider Demographics
NPI:1053837799
Name:NWAKANMA, CHIDINMA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CHIDINMA
Middle Name:
Last Name:NWAKANMA
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 1:4115 W AERIE DR APT 109
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-2417
Mailing Address - Country:US
Mailing Address - Phone:708-224-1397
Mailing Address - Fax:
Practice Address - Street 1:1900 W VALENCIA RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85746-6628
Practice Address - Country:US
Practice Address - Phone:520-807-2288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-15
Last Update Date:2017-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS022434183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist