Provider Demographics
NPI:1619241163
Name:AIMIUWU, CYNTHIA IJEOMA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:IJEOMA
Last Name:AIMIUWU
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:CYNTHIA
Other - Middle Name:IJEOMA
Other - Last Name:IWUOHA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:4333 PENINSULA DR
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-9392
Mailing Address - Country:US
Mailing Address - Phone:206-940-6710
Mailing Address - Fax:
Practice Address - Street 1:525 W ACACIA ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95203-2405
Practice Address - Country:US
Practice Address - Phone:209-944-5550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-01
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20074183500000X
GARPH025101183500000X
WAPH60091233183500000X
CA70428183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist