Julita Chinyere Agwumezie
Individual provider Active NPI Pharmacist · Hercules, CA
NPI 1407415144 · NPPES record last updated Jun 18, 2019
Key facts
- NPI
- 1407415144
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 57751 (CA)
- Practice address
- 1590 Sycamore Avenue
Hercules, CA 94547 - Phone
- (510) 415-1857
- NPI assigned
- Jun 6, 2019
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 57751 | CA | MD | Physician Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 57751 | CA | Yes |
Addresses
Primary practice location
1590 Sycamore Avenue
Hercules, CA 94547
Mailing address
1590 Sycamore Avenue
Hercules, CA 94547
Phone (510) 415-1857
Other providers in Hercules, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 18, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.