Provider Demographics
NPI:1629368626
Name:UGWU, NICHODEMUS C (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:NICHODEMUS
Middle Name:C
Last Name:UGWU
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 MARLEY MANOR DR
Mailing Address - Street 2:APT 203
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-8782
Mailing Address - Country:US
Mailing Address - Phone:202-445-7147
Mailing Address - Fax:
Practice Address - Street 1:12154 BRITTINGHAM LN
Practice Address - Street 2:RITE AID PHARMACY
Practice Address - City:PRINCESS ANNE
Practice Address - State:MD
Practice Address - Zip Code:21853-2212
Practice Address - Country:US
Practice Address - Phone:410-651-1133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18800183500000X
DCPH100000613183500000X
DEA1-000383183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist