Healthcare Provider Details

I. General information

NPI: 1033447628
Provider Name (Legal Business Name): MR. ADOLPHUS E ABAKWUE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2009
Last Update Date: 11/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 W CAMP WISDOM RD
DALLAS TX
75232-3536
US

IV. Provider business mailing address

1101 GLENCOE DR
GLENN HEIGHTS TX
75154-8692
US

V. Phone/Fax

Practice location:
  • Phone: 972-228-6738
  • Fax:
Mailing address:
  • Phone: 456-337-1592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28244
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: