MEDICARE: DR. BRYAN AJULUCHUKWU 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	51640	TX

General Provider Information

NPI Number	:	1881941961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRYAN AJULUCHUKWU PHARMD

Provider Business Mailing Address
First Line	:	906 ALLEN ST
Second Line	:	APT 1731
City	:	DALLAS
State	:	TX
Zip	:	75204-5789
Country	:	US
Telephone Number	:	630-607-2311
Fax Number	:

Provider Business Practice Location Address
First Line	:	906 ALLEN ST
Second Line	:	APT 1731
City	:	DALLAS
State	:	TX
Zip	:	75204-5789
Country	:	US
Telephone Number	:	630-607-2311
Fax Number	:

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

Provider Enumeration Date	:	08/08/2012
Last Update Date	:	08/08/2012

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