Provider Demographics
NPI:1568739811
Name:AWARAKA, CHINWENDU (PHARMD)
Entity Type:Individual
Prefix:
First Name:CHINWENDU
Middle Name:
Last Name:AWARAKA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 NORTH STATE HIGHWAY
Mailing Address - Street 2:3715
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-3509
Mailing Address - Country:US
Mailing Address - Phone:313-673-7647
Mailing Address - Fax:
Practice Address - Street 1:833 SW WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-5712
Practice Address - Country:US
Practice Address - Phone:817-447-4172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX49098183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist