Provider Demographics
NPI:1265190060
Name:NGWEPEKEM, LYDIE AKWESE
Entity type:Individual
Prefix:
First Name:LYDIE
Middle Name:AKWESE
Last Name:NGWEPEKEM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5904 LANTERN LN
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-8768
Mailing Address - Country:US
Mailing Address - Phone:954-268-7249
Mailing Address - Fax:
Practice Address - Street 1:5904 LANTERN LN
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-8768
Practice Address - Country:US
Practice Address - Phone:954-268-7249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69763183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist