Healthcare Provider Details

I. General information

NPI: 1922062801
Provider Name (Legal Business Name): KENNETH OKECHUKWU UKAUWA PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4820 N ROAD 68
PASCO WA
99301-9009
US

IV. Provider business mailing address

250 GAGE BLVD
RICHLAND WA
99352-9683
US

V. Phone/Fax

Practice location:
  • Phone: 509-543-7947
  • Fax: 509-543-7949
Mailing address:
  • Phone: 617-852-9062
  • Fax: 509-543-7949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number57225
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: