Provider Demographics
NPI:1437496270
Name:CHINWUBA, EDITH NGOZI
Entity Type:Individual
Prefix:MS
First Name:EDITH
Middle Name:NGOZI
Last Name:CHINWUBA
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 1:6030 14TH ST W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34207-4104
Mailing Address - Country:US
Mailing Address - Phone:941-756-4886
Mailing Address - Fax:
Practice Address - Street 1:6030 14TH ST W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-4104
Practice Address - Country:US
Practice Address - Phone:941-756-4886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS34407183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist