Provider Demographics
NPI:1689719957
Name:UGWU, IFEOMA
Entity Type:Individual
Prefix:
First Name:IFEOMA
Middle Name:
Last Name:UGWU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5153 HOLT BLVD
Mailing Address - Street 2:SUITE A-6
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-4820
Mailing Address - Country:US
Mailing Address - Phone:909-626-6300
Mailing Address - Fax:909-626-6322
Practice Address - Street 1:5153 HOLT BLVD
Practice Address - Street 2:SUITE A-6
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-4820
Practice Address - Country:US
Practice Address - Phone:909-626-6300
Practice Address - Fax:909-626-6322
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52199183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist