Provider Demographics
NPI:1184963688
Name:ETI-UKWU, ANTHONY (RPH)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:ETI-UKWU
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2399 S STATE ROAD 46
Mailing Address - Street 2:WALMART PHARMACY INC
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47803-9306
Mailing Address - Country:US
Mailing Address - Phone:812-872-2533
Mailing Address - Fax:
Practice Address - Street 1:2399 S STATE ROAD 46
Practice Address - Street 2:WALMART PHARMACY INC
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47803-9306
Practice Address - Country:US
Practice Address - Phone:812-872-2533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-05
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26023586A183500000X
IL051-294013183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist