Provider Demographics
NPI:1619400413
Name:EKWEALOR, NWADIOGBU MARK (PHARMD)
Entity Type:Individual
Prefix:
First Name:NWADIOGBU
Middle Name:MARK
Last Name:EKWEALOR
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 1:2000 MOUNTAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-2807
Mailing Address - Country:US
Mailing Address - Phone:510-339-8535
Mailing Address - Fax:510-339-8648
Practice Address - Street 1:2000 MOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-2807
Practice Address - Country:US
Practice Address - Phone:510-339-8535
Practice Address - Fax:510-339-8648
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-07
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA75326183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist