Provider Demographics
NPI:1205293297
Name:EKWELLE, EMADE E (PHARMD)
Entity type:Individual
Prefix:
First Name:EMADE
Middle Name:E
Last Name:EKWELLE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 RUSHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-5542
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9307 AGAVE AVE
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79765-2223
Practice Address - Country:US
Practice Address - Phone:013-184-0245
Practice Address - Fax:281-592-0459
Is Sole Proprietor?:No
Enumeration Date:2016-01-21
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX54187183500000X
ARR077643163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No183500000XPharmacy Service ProvidersPharmacist