Provider Demographics
NPI:1053908905
Name:NWAMBIE, ALPHONSUS IKECHUKWU (RPH, DBA)
Entity type:Individual
Prefix:
First Name:ALPHONSUS
Middle Name:IKECHUKWU
Last Name:NWAMBIE
Suffix:
Gender:M
Credentials:RPH, DBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9065 SW 172ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-2952
Mailing Address - Country:US
Mailing Address - Phone:512-905-8369
Mailing Address - Fax:
Practice Address - Street 1:9031 SW 107TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1414
Practice Address - Country:US
Practice Address - Phone:512-905-8369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-27
Last Update Date:2020-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS44789183500000X
FLPS44589183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist