Provider Demographics
NPI:1164767273
Name:AGUWA, UKACHI
Entity Type:Individual
Prefix:
First Name:UKACHI
Middle Name:
Last Name:AGUWA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 CROSS CLUB DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-4358
Mailing Address - Country:US
Mailing Address - Phone:513-520-3273
Mailing Address - Fax:
Practice Address - Street 1:3 CROSS CLUB DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-4358
Practice Address - Country:US
Practice Address - Phone:513-520-3273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13923183500000X
OH03331190183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist