Provider Demographics
NPI:1588848220
Name:MUOGHALU, PHILO OKWUY
Entity Type:Individual
Prefix:
First Name:PHILO
Middle Name:OKWUY
Last Name:MUOGHALU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4140 WILDER AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-2132
Mailing Address - Country:US
Mailing Address - Phone:718-324-7095
Mailing Address - Fax:
Practice Address - Street 1:239 E 198TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-3147
Practice Address - Country:US
Practice Address - Phone:718-933-1465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039523183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist