=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902578644
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UZENDU RX
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/01/2021
-----------------------------------------------------
Last Update Date | 10/01/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1551 WALL ST STE 110
-----------------------------------------------------
City | SAINT CHARLES
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63303-3540
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-493-9008
-----------------------------------------------------
Fax | 636-493-9008
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1551 WALL ST STE 110
-----------------------------------------------------
City | SAINT CHARLES
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63303-3540
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-493-9008
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST-IN-CHARGE
-----------------------------------------------------
Name | DR. GOZIE EZEKWU UZENDU
-----------------------------------------------------
Credential | PHARMD, MBA
-----------------------------------------------------
Telephone | 314-489-8582
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------