Provider Demographics
NPI:1144802935
Name:NWANKWO, UDOCHUKWU EDEN
Entity Type:Individual
Prefix:
First Name:UDOCHUKWU
Middle Name:EDEN
Last Name:NWANKWO
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 1:22803 US HIGHWAY 281 N APT 1201
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-2416
Mailing Address - Country:US
Mailing Address - Phone:832-745-6695
Mailing Address - Fax:
Practice Address - Street 1:1836 PAT BOOKER RD
Practice Address - Street 2:
Practice Address - City:UNIVERSAL CITY
Practice Address - State:TX
Practice Address - Zip Code:78148-3437
Practice Address - Country:US
Practice Address - Phone:210-658-8011
Practice Address - Fax:210-658-5402
Is Sole Proprietor?:No
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66320183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist