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General NPI Number Information
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NPI Number | 1386120806
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Entity Type | Individual
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Provider Name | UZOMA OBINNA MBOGU
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Gender | Male
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Dates
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Enumeration Date | 07/18/2018
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Last Update Date | 09/09/2021
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Provider Practice Location Address
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Address Line | 22316 70TH AVE W STE 5
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City | MOUNTLAKE TERRACE
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State | WA
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Zip | 98043-2184
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Country | US
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Telephone | 347-307-3304
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Fax |
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Provider Business Mailing Address
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Address Line | 1660 AURORA AVE N
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City | SEATTLE
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State | WA
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Zip | 98109-3060
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PH60850492
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License Number State | WA
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