Provider Demographics
NPI:1609007046
Name:NWANGWU, AFAM (RPH)
Entity Type:Individual
Prefix:
First Name:AFAM
Middle Name:
Last Name:NWANGWU
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 1:14445 OAKRIDGE CIR APT 2604
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76155-4821
Mailing Address - Country:US
Mailing Address - Phone:817-685-0169
Mailing Address - Fax:
Practice Address - Street 1:14445 OAKRIDGE CIR APT 2604
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76155-4821
Practice Address - Country:US
Practice Address - Phone:817-685-0169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-03
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45759183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist