Provider Demographics
NPI:1699285403
Name:IGWEBUIKE, NNAMDI MAXWELL
Entity type:Individual
Prefix:
First Name:NNAMDI
Middle Name:MAXWELL
Last Name:IGWEBUIKE
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 1:12809 FLAT CREEK DR
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-3105
Mailing Address - Country:US
Mailing Address - Phone:713-517-6594
Mailing Address - Fax:
Practice Address - Street 1:1701 W FM 646 RD
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-4968
Practice Address - Country:US
Practice Address - Phone:281-337-9713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-06
Last Update Date:2017-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61266183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist