Provider Demographics
NPI:1487256723
Name:NWAGBARA, CLETUS UGWUNNA (PHARMD)
Entity type:Individual
Prefix:
First Name:CLETUS
Middle Name:UGWUNNA
Last Name:NWAGBARA
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 1:2904 STONEWATER CT
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-6040
Mailing Address - Country:US
Mailing Address - Phone:678-978-9967
Mailing Address - Fax:678-757-9732
Practice Address - Street 1:2904 STONEWATER CT
Practice Address - Street 2:
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-6040
Practice Address - Country:US
Practice Address - Phone:678-978-9967
Practice Address - Fax:678-757-9732
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH018241183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist