Provider Demographics
NPI:1033447628
Name:ABAKWUE, ADOLPHUS E
Entity Type:Individual
Prefix:MR
First Name:ADOLPHUS
Middle Name:E
Last Name:ABAKWUE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 GLENCOE DR
Mailing Address - Street 2:
Mailing Address - City:GLENN HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:75154-8692
Mailing Address - Country:US
Mailing Address - Phone:456-337-1592
Mailing Address - Fax:
Practice Address - Street 1:1060 W CAMP WISDOM RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75232-3536
Practice Address - Country:US
Practice Address - Phone:972-228-6738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-19
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28244183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist