Healthcare Provider Details

I. General information

NPI: 1063864502
Provider Name (Legal Business Name): ONYEKACHI ENYINNAYA UKPABI JR. PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2016
Last Update Date: 07/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3605 COLLEGE ST
BEAUMONT TX
77701-4617
US

IV. Provider business mailing address

6298 BROOKRIDGE DR
FLOWERY BRANCH GA
30542-5378
US

V. Phone/Fax

Practice location:
  • Phone: 409-832-7374
  • Fax: 409-832-7863
Mailing address:
  • Phone: 678-656-8281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number57948
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: