Provider Demographics
NPI:1164002598
Name:MBAGWU, ALLWELL C (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ALLWELL
Middle Name:C
Last Name:MBAGWU
Suffix:
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 1:2123 LAUREL CREEK DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77014-2468
Mailing Address - Country:US
Mailing Address - Phone:713-480-2132
Mailing Address - Fax:
Practice Address - Street 1:20030 W LAKE HOUSTON PKWY
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-3177
Practice Address - Country:US
Practice Address - Phone:281-852-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-09
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX44668183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist