Healthcare Provider Details

I. General information

NPI: 1487943890
Provider Name (Legal Business Name): PERRY OGBUGO UKACHUKWU RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2011
Last Update Date: 04/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 SW COURT PL
PENDLETON OR
97801-1817
US

IV. Provider business mailing address

119 SE JAY AVE
PENDLETON OR
97801-3024
US

V. Phone/Fax

Practice location:
  • Phone: 541-276-1185
  • Fax: 541-278-1536
Mailing address:
  • Phone: 541-216-1577
  • Fax: 541-278-1356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH-0012056
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: