MEDICARE: FESTUS NJI MBAKWA PHARM D

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	60362	TX

General Provider Information

NPI Number	:	1922687235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FESTUS NJI MBAKWA PHARM D

Provider Business Mailing Address
First Line	:	3200 N BIG SPRING ST
Second Line	:
City	:	MIDLAND
State	:	TX
Zip	:	79705-5315
Country	:	US
Telephone Number	:	432-685-7008
Fax Number	:	432-203-8341

Provider Business Practice Location Address
First Line	:	3200 N BIG SPRING ST
Second Line	:
City	:	MIDLAND
State	:	TX
Zip	:	79705-5315
Country	:	US
Telephone Number	:	432-685-7008
Fax Number	:	432-203-8341

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

Provider Enumeration Date	:	04/05/2021
Last Update Date	:	04/05/2021

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