Provider Demographics
NPI:1972880466
Name:NWANKWO, MICHAEL ANENE (RPH)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ANENE
Last Name:NWANKWO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:183 E DAYTON YELLOW SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-3465
Mailing Address - Country:US
Mailing Address - Phone:937-878-2889
Mailing Address - Fax:937-878-3692
Practice Address - Street 1:183 E DAYTON YELLOW SPRINGS RD
Practice Address - Street 2:
Practice Address - City:FAIRBORN
Practice Address - State:OH
Practice Address - Zip Code:45324-3465
Practice Address - Country:US
Practice Address - Phone:937-878-2889
Practice Address - Fax:937-878-3692
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03318186183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist