Provider Demographics
NPI:1699002469
Name:UGEGE, JONATHAN USHIO (PHARMD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:USHIO
Last Name:UGEGE
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 1:816 FRANKLIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:ANTHONY
Mailing Address - State:TX
Mailing Address - Zip Code:79821-7185
Mailing Address - Country:US
Mailing Address - Phone:915-886-7222
Mailing Address - Fax:915-886-7226
Practice Address - Street 1:816 FRANKLIN ST STE A
Practice Address - Street 2:
Practice Address - City:ANTHONY
Practice Address - State:TX
Practice Address - Zip Code:79821
Practice Address - Country:US
Practice Address - Phone:915-886-7222
Practice Address - Fax:915-886-7226
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-16
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX43141183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist