Provider Demographics
NPI:1609002948
Name:NYAKWEBA, LAMECK (RPH)
Entity Type:Individual
Prefix:
First Name:LAMECK
Middle Name:
Last Name:NYAKWEBA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9221 E BASELINE RD STE A109-617
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-8310
Mailing Address - Country:US
Mailing Address - Phone:480-357-3904
Mailing Address - Fax:480-357-4639
Practice Address - Street 1:10750 W MCDOWELL RD BLDG A
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-5960
Practice Address - Country:US
Practice Address - Phone:623-932-9800
Practice Address - Fax:623-932-9817
Is Sole Proprietor?:No
Enumeration Date:2009-06-01
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS014278183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist