Provider Demographics
NPI:1841739265
Name:NTUEN, UDUAK (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:UDUAK
Middle Name:
Last Name:NTUEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2434 N SACRAMENTO AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-2666
Mailing Address - Country:US
Mailing Address - Phone:773-687-6346
Mailing Address - Fax:
Practice Address - Street 1:9617 GREAT HILLS TRL APT 1232
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-6382
Practice Address - Country:US
Practice Address - Phone:336-337-7149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-17
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.022188183500000X
IL051303564183500000X
NC24542183500000X
TX56230183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist