Provider Demographics
NPI:1891071163
Name:NWOKOLO, OSITADINMA AMOBICHUKWU (R PH)
Entity Type:Individual
Prefix:
First Name:OSITADINMA
Middle Name:AMOBICHUKWU
Last Name:NWOKOLO
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4401 CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43224-1577
Mailing Address - Country:US
Mailing Address - Phone:614-804-8600
Mailing Address - Fax:
Practice Address - Street 1:4401 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43224-1577
Practice Address - Country:US
Practice Address - Phone:614-476-5063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03225170183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist