1629368626 NPI number — DR. NICHODEMUS C UGWU PHARM D.

Table of content: DR. NICHODEMUS C UGWU PHARM D. (NPI 1629368626)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629368626 NPI number — DR. NICHODEMUS C UGWU PHARM D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
UGWU
Provider First Name:
NICHODEMUS
Provider Middle Name:
C
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARM D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629368626
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1016 MARLEY MANOR DR
Provider Second Line Business Mailing Address:
APT 203
Provider Business Mailing Address City Name:
SALISBURY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21804-8782
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-445-7147
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12154 BRITTINGHAM LN
Provider Second Line Business Practice Location Address:
RITE AID PHARMACY
Provider Business Practice Location Address City Name:
PRINCESS ANNE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21853-2212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-651-1133
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/11/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  18800 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 183500000X , with the licence number: PH100000613 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 183500000X , with the licence number: A1-000383 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)