Provider Demographics
NPI:1073896684
Name:NWABUEZE, MARTIN CHUKWUKELUO (RPH)
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:CHUKWUKELUO
Last Name:NWABUEZE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AYER
Mailing Address - State:MA
Mailing Address - Zip Code:01432-1339
Mailing Address - Country:US
Mailing Address - Phone:978-772-7325
Mailing Address - Fax:
Practice Address - Street 1:50 MAIN ST
Practice Address - Street 2:
Practice Address - City:AYER
Practice Address - State:MA
Practice Address - Zip Code:01432-1339
Practice Address - Country:US
Practice Address - Phone:978-772-7325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH233390183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist