Provider Demographics
NPI:1962006197
Name:AWONDO, NELSON T
Entity Type:Individual
Prefix:
First Name:NELSON
Middle Name:T
Last Name:AWONDO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 N MIDLAND DR APT 23F
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-4622
Mailing Address - Country:US
Mailing Address - Phone:706-254-5213
Mailing Address - Fax:
Practice Address - Street 1:3909 E 42ND ST
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79762-5939
Practice Address - Country:US
Practice Address - Phone:432-366-1913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-29
Last Update Date:2020-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63426183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist