Provider Demographics
NPI:1730644196
Name:NWANKWO, KENNETH CHIKE (RPH)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:CHIKE
Last Name:NWANKWO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2817 GARDEN OAKS PL
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-4402
Mailing Address - Country:US
Mailing Address - Phone:214-274-0023
Mailing Address - Fax:
Practice Address - Street 1:2817 GARDEN OAKS PL
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-4402
Practice Address - Country:US
Practice Address - Phone:214-274-0023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-09
Last Update Date:2019-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX305173336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy