Individual provider Active NPI

Chinazor Vivian Egbuonu, RPH

  • Pharmacist
  • Redondo Beach, CA
National Provider Identifier
1871315473
Registry record updated Oct 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
90114 Issued in CA
Practice address
2115 Artesia Blvd
Redondo Beach, CA 90278-3013
Phone
(310) 675-0359
NPI assigned
Oct 26, 2024
Last updated
Oct 26, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 26, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 90114 CA Primary

Addresses

Primary practice location

2115 Artesia Blvd
Redondo Beach, CA 90278-3013

Mailing address

13611 Kornblum Ave Apt 21
Hawthorne, CA 90250-9611

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
Credentials
Registered Pharmacist

State licenses

LicenseStateTypeSpecialty
90114CAMDPharmacist

NPI Registry JSON

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

{
    "created_epoch": "1729900800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729900800000",
    "number": "1871315473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13611 KORNBLUM AVE APT 21",
            "city": "HAWTHORNE",
            "state": "CA",
            "postal_code": "902509611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2115 ARTESIA BLVD",
            "city": "REDONDO BEACH",
            "state": "CA",
            "postal_code": "902783013",
            "telephone_number": "310-675-0359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EGBUONU",
        "first_name": "CHINAZOR",
        "middle_name": "VIVIAN",
        "credential": "RPH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-10-26",
        "last_updated": "2024-10-26",
        "certification_date": "2024-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "CA",
            "license": "90114",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Redondo Beach, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2024; 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.