Provider Demographics
NPI:1659129500
Name:NWOKEM, ETHELBERT UCHE KEVIN
Entity type:Individual
Prefix:DR
First Name:ETHELBERT
Middle Name:UCHE KEVIN
Last Name:NWOKEM
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 1:10114 ELDER MILL LN
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77498-5026
Mailing Address - Country:US
Mailing Address - Phone:713-492-6568
Mailing Address - Fax:
Practice Address - Street 1:12240 MURPHY RD STE B
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-2411
Practice Address - Country:US
Practice Address - Phone:832-516-8468
Practice Address - Fax:713-597-8196
Is Sole Proprietor?:No
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX48524183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist