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General NPI Number Information
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NPI Number | 1275006355
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Entity Type | Organization
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Legal Business Name | EICCUA LLC
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Dates
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Enumeration Date | 01/10/2019
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Last Update Date | 01/10/2019
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Provider Practice Location Address
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Address Line | 404 NASH ST S
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City | WILSON
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State | NC
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Zip | 27893-3888
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Country | US
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Telephone | 252-293-4177
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Fax | 252-293-4180
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Provider Business Mailing Address
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Address Line | 404 NASH ST S
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City | WILSON
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State | NC
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Zip | 27893-3888
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Country | US
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Telephone | 252-293-4177
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Fax | 252-293-4180
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | IJEOMA AGNES UWAKWE
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Credential |
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Telephone | 252-293-4177
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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