Provider Demographics
NPI:1053755777
Name:AGUOCHA, IHEANYI ONUMON (RPH)
Entity type:Individual
Prefix:MR
First Name:IHEANYI
Middle Name:ONUMON
Last Name:AGUOCHA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2770 BARDIN ROAD
Mailing Address - Street 2:APT 7309
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052
Mailing Address - Country:US
Mailing Address - Phone:972-375-1189
Mailing Address - Fax:
Practice Address - Street 1:2770 BARDIN RD
Practice Address - Street 2:APT 7309
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-3841
Practice Address - Country:US
Practice Address - Phone:972-375-2289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-24
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28766183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist