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General NPI Number Information
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NPI Number | 1871927624
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Entity Type | Individual
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Provider Name | GRACE IFUNANYA MBAGWU PHARMD
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Gender | Female
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Dates
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Enumeration Date | 08/29/2013
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Last Update Date | 09/04/2013
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Provider Practice Location Address
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Address Line | 463 WESTFIELD BLVD APT. 612
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City | TEMPLE
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State | TX
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Zip | 76502-5333
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Country | US
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Telephone | 254-298-2123
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Fax |
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Provider Business Mailing Address
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Address Line | 1206 WEST CAMPUS DRIVE
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City | TEMPLE
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State | TX
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Zip | 76502-5318
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Country | US
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Telephone | 254-298-6100
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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 | 53800
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License Number State | TX
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