Provider Demographics
NPI:1770146854
Name:AGBO, NGOZI BEATRICE
Entity type:Individual
Prefix:
First Name:NGOZI
Middle Name:BEATRICE
Last Name:AGBO
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 1:11550 MERIDIAN MARKET VW
Mailing Address - Street 2:
Mailing Address - City:FALCON
Mailing Address - State:CO
Mailing Address - Zip Code:80831-8241
Mailing Address - Country:US
Mailing Address - Phone:719-522-2989
Mailing Address - Fax:719-522-2991
Practice Address - Street 1:11550 MERIDIAN MARKET VW
Practice Address - Street 2:
Practice Address - City:FALCON
Practice Address - State:CO
Practice Address - Zip Code:80831-8241
Practice Address - Country:US
Practice Address - Phone:719-522-2989
Practice Address - Fax:719-522-2991
Is Sole Proprietor?:No
Enumeration Date:2019-04-15
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO19420183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist