Provider Demographics
NPI:1508498742
Name:UGBOH, KRISTINE (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:UGBOH
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2423 ELMHURST AVE
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-2822
Mailing Address - Country:US
Mailing Address - Phone:515-297-3049
Mailing Address - Fax:
Practice Address - Street 1:115 S 29TH ST
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-2906
Practice Address - Country:US
Practice Address - Phone:515-576-5320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-05
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA22529183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist