Provider Demographics
NPI:1043664477
Name:MADUSQUE, UCHECHUKWU
Entity Type:Individual
Prefix:
First Name:UCHECHUKWU
Middle Name:
Last Name:MADUSQUE
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 1:23214 SESAME ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-3045
Mailing Address - Country:US
Mailing Address - Phone:909-232-4048
Mailing Address - Fax:
Practice Address - Street 1:3335 S FIGUEROA ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90007-3840
Practice Address - Country:US
Practice Address - Phone:213-742-6765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-22
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA67129183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist