MEDICARE: DR. GLORIA IFEOMA IGBOANUGO I PHARMD.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	S016011	AZ
2	183500000X	Pharmacist	61114	TX

General Provider Information

NPI Number	:	1619490364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GLORIA IFEOMA IGBOANUGO I PHARMD.

Provider Business Mailing Address
First Line	:	23144 CINCO RANCH BLVD STE PMB 1094
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77494-2894
Country	:	US
Telephone Number	:	480-310-0564
Fax Number	:

Provider Business Practice Location Address
First Line	:	1801 S VOSS RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77057-2605
Country	:	US
Telephone Number	:	480-310-0564
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2017
Last Update Date	:	06/02/2026

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