Provider Demographics
NPI:1578165064
Name:MWESIGA, INNOCENT THADEO (PHARMD)
Entity Type:Individual
Prefix:
First Name:INNOCENT
Middle Name:THADEO
Last Name:MWESIGA
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 1:7434 ROSEPATH LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-2085
Mailing Address - Country:US
Mailing Address - Phone:832-549-9806
Mailing Address - Fax:
Practice Address - Street 1:2200 BRIARCREST DR
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-5000
Practice Address - Country:US
Practice Address - Phone:979-776-0375
Practice Address - Fax:797-776-0561
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX52031183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist