MEDICARE: DR. ROY NWAKAMMA PHARM D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	42891	TX

General Provider Information

NPI Number	:	1760007744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROY NWAKAMMA PHARM D.

Provider Business Mailing Address
First Line	:	701 SIERRA AVE
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-1885
Country	:	US
Telephone Number	:	713-817-3205
Fax Number	:

Provider Business Practice Location Address
First Line	:	4501 E LANCASTER AVE # 105
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76103-3210
Country	:	US
Telephone Number	:	682-224-2705
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2020
Last Update Date	:	06/15/2020

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Directions to “ DR. ROY NWAKAMMA PHARM D.” Practice Location

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