Provider Demographics
NPI:1376122291
Name:ONYEGBULE, WISDOM CHUKWUDI (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:WISDOM
Middle Name:CHUKWUDI
Last Name:ONYEGBULE
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 1:7035 HOBBY WIND RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77075-1430
Mailing Address - Country:US
Mailing Address - Phone:217-255-3992
Mailing Address - Fax:
Practice Address - Street 1:3939 HILLCROFT ST STE 120
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-7733
Practice Address - Country:US
Practice Address - Phone:713-465-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62614183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist