Provider Demographics
NPI:1235742875
Name:NNANI, JOSEPH IJEOMAH (PHARMD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:IJEOMAH
Last Name:NNANI
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 1:300 E 18TH ST APT 1
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-6313
Mailing Address - Country:US
Mailing Address - Phone:682-472-4210
Mailing Address - Fax:
Practice Address - Street 1:US HIGHWAY 491 NORTH
Practice Address - Street 2:
Practice Address - City:SHIPROCK
Practice Address - State:NM
Practice Address - Zip Code:87420-1816
Practice Address - Country:US
Practice Address - Phone:505-368-7265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS024818183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist