Provider Demographics
NPI:1649581919
Name:ENWEREM, GOZIE NNEKA (PHARM D)
Entity Type:Individual
Prefix:
First Name:GOZIE
Middle Name:NNEKA
Last Name:ENWEREM
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11096 JEFFERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-5520
Mailing Address - Country:US
Mailing Address - Phone:310-397-3931
Mailing Address - Fax:
Practice Address - Street 1:11096 JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-5520
Practice Address - Country:US
Practice Address - Phone:310-397-3931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-01
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59076183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA59076OtherPHARMACIST LICENSE