Provider Demographics
NPI:1447853726
Name:NWANGWU, ONYINYE THEODORA, IJEOMA
Entity type:Individual
Prefix:
First Name:ONYINYE
Middle Name:THEODORA, IJEOMA
Last Name:NWANGWU
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 1:11830 LELDA LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77071-3291
Mailing Address - Country:US
Mailing Address - Phone:814-873-5425
Mailing Address - Fax:
Practice Address - Street 1:7102 BEECHNUT ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-5926
Practice Address - Country:US
Practice Address - Phone:713-771-6652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67069183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist