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General NPI Number Information
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NPI Number | 1578165064
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Entity Type | Individual
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Provider Name | INNOCENT THADEO MWESIGA PHARMD
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Gender | Male
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Dates
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Enumeration Date | 11/10/2020
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Last Update Date | 11/10/2020
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Provider Practice Location Address
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Address Line | 2200 BRIARCREST DR
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City | BRYAN
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State | TX
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Zip | 77802-5000
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Country | US
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Telephone | 979-776-0375
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Fax | 797-776-0561
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Provider Business Mailing Address
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Address Line | 7434 ROSEPATH LN
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City | RICHMOND
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State | TX
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Zip | 77407-2085
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Country | US
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Telephone | 832-549-9806
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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 | 52031
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License Number State | TX
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