Provider Demographics
NPI:1932879962
Name:OGU, UDOCHUKWU CALEB
Entity Type:Individual
Prefix:DR
First Name:UDOCHUKWU
Middle Name:CALEB
Last Name:OGU
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 1:1620 S BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-4260
Mailing Address - Country:US
Mailing Address - Phone:903-533-0367
Mailing Address - Fax:
Practice Address - Street 1:1620 S BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-4260
Practice Address - Country:US
Practice Address - Phone:903-533-0367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX689333183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist