Individual provider Active NPI

Ifeyinwa B Nwolisa

  • Pharmacist
  • El Paso, TX
National Provider Identifier
1861006736
Registry record updated Sep 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
66930 Issued in TX
Practice address
1801 N Oregon St
El Paso, TX 79902-3524
Phone
(915) 521-6110
NPI assigned
Sep 8, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 66930 TX Primary

Addresses

Primary practice location

1801 N Oregon St
El Paso, TX 79902-3524

Mailing address

4104 Cisco Valley Dr
Round Rock, TX 78664-3939
Phone (512) 552-6340

Other practice location 1

5305 Montana Ave
El Paso, TX 79903-4907
Phone (915) 772-2824

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
66930TXMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
CVS Pharmacy Inc Past Accepting new patients
CVS Pharmacy Inc Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1599523200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632096000000",
    "number": "1861006736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4104 CISCO VALLEY DR",
            "city": "ROUND ROCK",
            "state": "TX",
            "postal_code": "786643939",
            "telephone_number": "512-552-6340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 N OREGON ST",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799023524",
            "telephone_number": "915-521-6110"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5305 Montana Ave",
            "address_purpose": "LOCATION",
            "city": "El Paso",
            "state": "TX",
            "postal_code": "799034907",
            "country_code": "US",
            "telephone_number": "915-772-2824",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NWOLISA",
        "first_name": "IFEYINWA",
        "middle_name": "B",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-08",
        "last_updated": "2021-09-20",
        "certification_date": "2021-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "TX",
            "license": "66930",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in El Paso, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.