Provider Demographics
NPI:1730893504
Name:EICCUA LLC
Entity type:Organization
Organization Name:EICCUA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:IJEOMA
Authorized Official - Middle Name:AGNES
Authorized Official - Last Name:UWAKWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-293-4177
Mailing Address - Street 1:404 NASH ST EAST
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893
Mailing Address - Country:US
Mailing Address - Phone:252-293-4177
Mailing Address - Fax:252-293-4180
Practice Address - Street 1:404 NASH ST EAST
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893
Practice Address - Country:US
Practice Address - Phone:252-293-4177
Practice Address - Fax:252-293-4180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-06
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1629477377Medicaid