Provider Demographics
NPI:1184738809
Name:MOMON-UGWU, RENEE MASHELL (PHARMD, BCNSP)
Entity type:Individual
Prefix:DR
First Name:RENEE
Middle Name:MASHELL
Last Name:MOMON-UGWU
Suffix:
Gender:F
Credentials:PHARMD, BCNSP
Other - Prefix:DR
Other - First Name:RENEE
Other - Middle Name:MASHELL
Other - Last Name:MOMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:19051 NW 78TH PL
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-2758
Mailing Address - Country:US
Mailing Address - Phone:305-829-8219
Mailing Address - Fax:
Practice Address - Street 1:1201 NW 16TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-1624
Practice Address - Country:US
Practice Address - Phone:305-575-7000
Practice Address - Fax:305-575-3386
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA16149183500000X
FLPS252951835N1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered183500000XPharmacy Service ProvidersPharmacist
Not Answered1835N1003XPharmacy Service ProvidersPharmacistNutrition Support