Provider Demographics
NPI:1760007744
Name:NWAKAMMA, ROY (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:
Last Name:NWAKAMMA
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 1:701 SIERRA AVE
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-1885
Mailing Address - Country:US
Mailing Address - Phone:713-817-3205
Mailing Address - Fax:
Practice Address - Street 1:4501 E LANCASTER AVE # 105
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76103-3210
Practice Address - Country:US
Practice Address - Phone:682-224-2705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-15
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX42891183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist