Healthcare Provider Details

I. General information

NPI: 1205698909
Provider Name (Legal Business Name): ANGELA CHIDUMEM UZEGBU PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2024
Last Update Date: 01/29/2024
Certification Date: 01/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11923 US HIGHWAY 290 E
MANOR TX
78653-4321
US

IV. Provider business mailing address

15114 BARBADO RIDGE TRL
CYPRESS TX
77433-7320
US

V. Phone/Fax

Practice location:
  • Phone: 512-651-9128
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number73680
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: