Provider Demographics
NPI:1699428318
Name:UGWU, MARTIN UZOCHUKWU
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:UZOCHUKWU
Last Name:UGWU
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 1:501 E HOUGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:WEST BRANCH
Mailing Address - State:MI
Mailing Address - Zip Code:48661-1131
Mailing Address - Country:US
Mailing Address - Phone:989-345-0080
Mailing Address - Fax:989-343-0113
Practice Address - Street 1:501 E HOUGHTON AVE
Practice Address - Street 2:
Practice Address - City:WEST BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48661-1131
Practice Address - Country:US
Practice Address - Phone:989-345-0080
Practice Address - Fax:989-343-0113
Is Sole Proprietor?:No
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302412174183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist