Provider Demographics
NPI:1063864502
Name:UKPABI, ONYEKACHI ENYINNAYA JR (PHARMD)
Entity Type:Individual
Prefix:
First Name:ONYEKACHI
Middle Name:ENYINNAYA
Last Name:UKPABI
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6298 BROOKRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FLOWERY BRANCH
Mailing Address - State:GA
Mailing Address - Zip Code:30542-5378
Mailing Address - Country:US
Mailing Address - Phone:678-656-8281
Mailing Address - Fax:
Practice Address - Street 1:3605 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4617
Practice Address - Country:US
Practice Address - Phone:409-832-7374
Practice Address - Fax:409-832-7863
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-08
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX57948183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist