Provider Demographics
NPI:1508177742
Name:NWEKE, OBIANANMA GRACE (RPH)
Entity Type:Individual
Prefix:
First Name:OBIANANMA
Middle Name:GRACE
Last Name:NWEKE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2906 HOUSTON HWY
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-4681
Mailing Address - Country:US
Mailing Address - Phone:361-576-5458
Mailing Address - Fax:
Practice Address - Street 1:2906 HOUSTON HWY
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-4681
Practice Address - Country:US
Practice Address - Phone:361-576-5458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-22
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38456183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist