Provider Demographics
NPI:1558748509
Name:AWUGOSI, JUSTINA CHIKA
Entity Type:Individual
Prefix:
First Name:JUSTINA
Middle Name:CHIKA
Last Name:AWUGOSI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JUSTINA
Other - Middle Name:CHIKA
Other - Last Name:EGWUAGU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:20906 FAIRWALNUT WAY
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11715 S GLEN DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77099-2500
Practice Address - Country:US
Practice Address - Phone:832-713-5327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-29
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX54477183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist