Healthcare Provider Details

I. General information

NPI: 1609220888
Provider Name (Legal Business Name): IFEOMA UWAGBOE RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2016
Last Update Date: 04/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 HIGHWAY 365
PORT ARTHUR TX
77642-7709
US

IV. Provider business mailing address

3700 HIGHWAY 365
PORT ARTHUR TX
77642-7709
US

V. Phone/Fax

Practice location:
  • Phone: 409-724-1914
  • Fax:
Mailing address:
  • Phone: 409-724-1914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number57891
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: