Provider Demographics
NPI:1902120967
Name:MATOKE, ERIC ONYANCHA (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:ONYANCHA
Last Name:MATOKE
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14041 NORTHWEST BLVD
Mailing Address - Street 2:STE 2B
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78410-5137
Mailing Address - Country:US
Mailing Address - Phone:361-767-1300
Mailing Address - Fax:361-767-8888
Practice Address - Street 1:14041 NORTHWEST BLVD
Practice Address - Street 2:STE 2B
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78410-5137
Practice Address - Country:US
Practice Address - Phone:361-767-1300
Practice Address - Fax:361-767-8888
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-19
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33391183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist