Provider Demographics
NPI:1881420420
Name:NKWETIE, INNOCENT (PHARMD)
Entity type:Individual
Prefix:
First Name:INNOCENT
Middle Name:
Last Name:NKWETIE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18815 CARLISLE LANDING LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-3053
Mailing Address - Country:US
Mailing Address - Phone:832-469-2801
Mailing Address - Fax:
Practice Address - Street 1:6900 GRAND MISSION BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-5404
Practice Address - Country:US
Practice Address - Phone:281-239-6517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74467183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist