Provider Demographics
NPI:1750981387
Name:ONUKWUFOR, NGOZI JESSICA
Entity type:Individual
Prefix:
First Name:NGOZI
Middle Name:JESSICA
Last Name:ONUKWUFOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 BEECHCREEK DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76134-3423
Mailing Address - Country:US
Mailing Address - Phone:281-935-2082
Mailing Address - Fax:
Practice Address - Street 1:1221 FM 1187 E
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:TX
Practice Address - Zip Code:76036-4370
Practice Address - Country:US
Practice Address - Phone:682-233-7841
Practice Address - Fax:682-233-7835
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-01
Last Update Date:2020-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX48230183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist