Provider Demographics
NPI:1619329869
Name:NWOGU, DAVID (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:NWOGU
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:DR
Other - First Name:DAVID
Other - Middle Name:
Other - Last Name:NWOGU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARM D
Mailing Address - Street 1:1013 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11221-2771
Mailing Address - Country:US
Mailing Address - Phone:212-920-4500
Mailing Address - Fax:
Practice Address - Street 1:1013 BROADWAY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11221-2771
Practice Address - Country:US
Practice Address - Phone:212-920-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-11
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03662100183500000X
NY061754183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist