NPIMap

Nathaniel Ekezie Ozurumba

Individual provider Active NPI Pharmacist · Broussard, LA

NPI 1972093235 · NPPES record last updated Jan 5, 2023

Key facts

NPI
1972093235
Entity type
Individual (NPI type 1)
Primary specialty
Pharmacist 183500000X
License
PST.022452 (LA)
Practice address
105 Saint Nazaire Rd
Broussard, LA 70518-4202
Phone
(337) 837-1640
NPI assigned
May 12, 2018
Sex
Male
Sole proprietor
Yes

Organizations & group practices 4

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.

Medicare participation

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

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
PST.022452LAMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Walgreen Co Current
since Jan 8, 2023		 Accepting new patients
Walgreen Louisiana Co Inc Past Accepting new patients
Walgreen Louisiana Co Inc Past Accepting new patients
Walgreen Co Past
since Jan 8, 2023		 Accepting new patients

Locations

105 Saint Nazaire Rd
Broussard, LA 70518
Phone (337) 837-1640

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X PST.022452 LA Yes

Addresses

Primary practice location

105 Saint Nazaire Rd
Broussard, LA 70518-4202

Mailing address

105 Saint Nazaire Rd
Broussard, LA 70518-4202

Other identifiers

IdentifierTypeStateIssuer
PST.022452OtherLAPHARMACIST LICENSE

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jan 5, 2023.

{
    "created_epoch": "1526083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672876800000",
    "number": "1972093235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 SAINT NAZAIRE RD",
            "city": "BROUSSARD",
            "state": "LA",
            "postal_code": "705184202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 SAINT NAZAIRE RD",
            "city": "BROUSSARD",
            "state": "LA",
            "postal_code": "705184202",
            "telephone_number": "337-837-1640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OZURUMBA",
        "first_name": "NATHANIEL",
        "middle_name": "EKEZIE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-05-12",
        "last_updated": "2023-01-05",
        "certification_date": "2023-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "LA",
            "license": "PST.022452",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACIST LICENSE",
            "identifier": "PST.022452",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Broussard, LA

All providers in Broussard, LA · Pharmacist in Louisiana

Sources for this page

Verify at the official NPI Registry.