Provider Demographics
NPI:1548584048
Name:TUSWA, NOCAMAGU (RPH)
Entity Type:Individual
Prefix:
First Name:NOCAMAGU
Middle Name:
Last Name:TUSWA
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 1:650 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-3705
Mailing Address - Country:US
Mailing Address - Phone:718-623-9633
Mailing Address - Fax:718-623-9842
Practice Address - Street 1:650 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-3705
Practice Address - Country:US
Practice Address - Phone:718-623-9633
Practice Address - Fax:718-623-9842
Is Sole Proprietor?:No
Enumeration Date:2010-03-26
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037218183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02513326Medicaid
NY5086610001Medicare NSC