Provider Demographics
NPI:1902206022
Name:NDUKA, AGNES CHUKWUDALU
Entity Type:Individual
Prefix:
First Name:AGNES
Middle Name:CHUKWUDALU
Last Name:NDUKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 ROUTE 303
Mailing Address - Street 2:
Mailing Address - City:VALLEY COTTAGE
Mailing Address - State:NY
Mailing Address - Zip Code:10989-5900
Mailing Address - Country:US
Mailing Address - Phone:845-268-4765
Mailing Address - Fax:
Practice Address - Street 1:203 S PLANK RD
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-2553
Practice Address - Country:US
Practice Address - Phone:845-566-0012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-26
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY059435183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist