Provider Demographics
NPI:1265702989
Name:NWANKWO, SOPURUCHI
Entity type:Individual
Prefix:
First Name:SOPURUCHI
Middle Name:
Last Name:NWANKWO
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 1:510 N ALAMO RD
Mailing Address - Street 2:
Mailing Address - City:ALAMO
Mailing Address - State:TX
Mailing Address - Zip Code:78516-2306
Mailing Address - Country:US
Mailing Address - Phone:956-782-4779
Mailing Address - Fax:
Practice Address - Street 1:510 N ALAMO RD
Practice Address - Street 2:
Practice Address - City:ALAMO
Practice Address - State:TX
Practice Address - Zip Code:78516-2306
Practice Address - Country:US
Practice Address - Phone:956-782-4779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX46085183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist