Healthcare Provider Details

I. General information

NPI: 1124375902
Provider Name (Legal Business Name): NNEKA AGWA PHARM. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2012
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 HIGHLAND CORPORATE DR
CUMBERLAND RI
02864-8703
US

IV. Provider business mailing address

43 CARYL RD
STOUGHTON MA
02072-2024
US

V. Phone/Fax

Practice location:
  • Phone: 866-908-2343
  • Fax:
Mailing address:
  • Phone: 617-417-7900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH234270
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: