Provider Demographics
NPI:1932418241
Name:NWOSU, DICKSON C (RPH)
Entity Type:Individual
Prefix:
First Name:DICKSON
Middle Name:C
Last Name:NWOSU
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7808 KEENAN RD
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-4854
Mailing Address - Country:US
Mailing Address - Phone:410-760-2172
Mailing Address - Fax:410-760-2172
Practice Address - Street 1:92 SOUDER RD
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:MD
Practice Address - Zip Code:21716-1245
Practice Address - Country:US
Practice Address - Phone:301-834-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-04
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12238183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist