Provider Demographics
NPI:1770310153
Name:NWOGU, KINGSLEY OGBONNA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KINGSLEY
Middle Name:OGBONNA
Last Name:NWOGU
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 WOODWARD ST APT E11
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-5137
Mailing Address - Country:US
Mailing Address - Phone:267-270-8397
Mailing Address - Fax:
Practice Address - Street 1:2301 WOODWARD ST APT E11
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-5137
Practice Address - Country:US
Practice Address - Phone:267-270-8397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP4555703336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy