Provider Demographics
NPI:1326556689
Name:ANYANWU, ROSEMARY NWAKAEGO
Entity Type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:NWAKAEGO
Last Name:ANYANWU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16647 PARSLEY LN
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92337-7621
Mailing Address - Country:US
Mailing Address - Phone:281-408-3241
Mailing Address - Fax:909-666-7617
Practice Address - Street 1:12549 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91739-9317
Practice Address - Country:US
Practice Address - Phone:909-899-7742
Practice Address - Fax:909-899-1470
Is Sole Proprietor?:No
Enumeration Date:2018-01-19
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA667731835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA66773OtherCALIFORNIA LICENSE