Provider Demographics
NPI:1093327348
Name:AWARAKA, OSONDU NNAMDI
Entity Type:Individual
Prefix:DR
First Name:OSONDU
Middle Name:NNAMDI
Last Name:AWARAKA
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 1:1673 ST HWY 100
Mailing Address - Street 2:
Mailing Address - City:PORT ISABEL
Mailing Address - State:TX
Mailing Address - Zip Code:78578-2806
Mailing Address - Country:US
Mailing Address - Phone:956-943-3754
Mailing Address - Fax:956-943-7048
Practice Address - Street 1:1673 ST HWY 100
Practice Address - Street 2:
Practice Address - City:PORT ISABEL
Practice Address - State:TX
Practice Address - Zip Code:78578-2806
Practice Address - Country:US
Practice Address - Phone:956-943-3754
Practice Address - Fax:956-943-7048
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX59946183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist