Provider Demographics
NPI:1336752583
Name:ADIGWE, OLISAELOKA (RPH)
Entity Type:Individual
Prefix:DR
First Name:OLISAELOKA
Middle Name:
Last Name:ADIGWE
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 1:5701 SARATOGA BLVD APT 635
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-4144
Mailing Address - Country:US
Mailing Address - Phone:978-606-1127
Mailing Address - Fax:
Practice Address - Street 1:5601 SARATOGA BLVD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-4109
Practice Address - Country:US
Practice Address - Phone:361-980-0501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-27
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63703183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist