Provider Demographics
NPI:1518240142
Name:MGBAM, ANDREWPHILIP CHUKWUJIEKWU (BPHARM)
Entity type:Individual
Prefix:MR
First Name:ANDREWPHILIP
Middle Name:CHUKWUJIEKWU
Last Name:MGBAM
Suffix:
Gender:M
Credentials:BPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 TURNBRIDGE WELLES
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-7878
Mailing Address - Country:US
Mailing Address - Phone:347-845-9308
Mailing Address - Fax:
Practice Address - Street 1:1042 NORD AVE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-4308
Practice Address - Country:US
Practice Address - Phone:530-566-1358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63516183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist