Provider Demographics
NPI:1194001701
Name:UBAECHU, MOSES ANOS
Entity Type:Individual
Prefix:DR
First Name:MOSES
Middle Name:ANOS
Last Name:UBAECHU
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:MOSES
Other - Middle Name:ANOS
Other - Last Name:UBAECHU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1120 N LOOP 336 W
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77301-1156
Mailing Address - Country:US
Mailing Address - Phone:936-760-4116
Mailing Address - Fax:936-760-4071
Practice Address - Street 1:1120 N LOOP 336 W
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77301-1156
Practice Address - Country:US
Practice Address - Phone:936-760-4116
Practice Address - Fax:936-760-4071
Is Sole Proprietor?:No
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX44725183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist