Provider Demographics
NPI:1881197713
Name:UDE, UDE UCHE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:UDE
Middle Name:UCHE
Last Name:UDE
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 1:118A EDNA
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65583-7875
Mailing Address - Country:US
Mailing Address - Phone:314-600-5329
Mailing Address - Fax:
Practice Address - Street 1:118 EDNA
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:MO
Practice Address - Zip Code:65583-7875
Practice Address - Country:US
Practice Address - Phone:314-600-5329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-16
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20130319241835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2013031924OtherSTATE LICENSE