Provider Demographics
NPI:1629675210
Name:ANUGWOM, IFEOMA GLORIA (PHARMD)
Entity Type:Individual
Prefix:
First Name:IFEOMA
Middle Name:GLORIA
Last Name:ANUGWOM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15911 WILLIWAW DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-5373
Mailing Address - Country:US
Mailing Address - Phone:832-679-5034
Mailing Address - Fax:
Practice Address - Street 1:1201 ELLEN TROUT DR
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-1233
Practice Address - Country:US
Practice Address - Phone:936-634-8155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64212183500000X
LA023416183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist