Provider Demographics
NPI:1699042135
Name:NNODIM, UGONNA (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:UGONNA
Middle Name:
Last Name:NNODIM
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 1:1235 E CHARLESTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-1708
Mailing Address - Country:US
Mailing Address - Phone:702-209-3640
Mailing Address - Fax:702-209-3641
Practice Address - Street 1:1235 E CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-1708
Practice Address - Country:US
Practice Address - Phone:702-209-3640
Practice Address - Fax:702-209-3641
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-29
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00007764183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist