Provider Demographics
NPI:1275880049
Name:EKENGA, VINCENT (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:
Last Name:EKENGA
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4921 N GALLOWAY AVE APT 132
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-1542
Mailing Address - Country:US
Mailing Address - Phone:314-571-8201
Mailing Address - Fax:
Practice Address - Street 1:1520 PIONEER RD
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-6033
Practice Address - Country:US
Practice Address - Phone:972-288-8287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-10
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51936183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist