Provider Demographics
NPI:1386244390
Name:UGWOKE, ELENA
Entity type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:UGWOKE
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 1:14268 FOX CHASE CT
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-4951
Mailing Address - Country:US
Mailing Address - Phone:574-387-9706
Mailing Address - Fax:
Practice Address - Street 1:175 COUNTY ROAD 6 W
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-5557
Practice Address - Country:US
Practice Address - Phone:574-266-7459
Practice Address - Fax:574-266-7461
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26026434A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN26026434AOtherPHARMACY