Provider Demographics
NPI:1124209648
Name:NOMAMIUKOR, JONATHAN O (RPH)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:O
Last Name:NOMAMIUKOR
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 1:2104 POST WOOD LN
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76018-3138
Mailing Address - Country:US
Mailing Address - Phone:817-467-5004
Mailing Address - Fax:956-796-2517
Practice Address - Street 1:1700 E SAUNDERS ST
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-5474
Practice Address - Country:US
Practice Address - Phone:956-796-2515
Practice Address - Fax:956-796-2517
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29790183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist