Provider Demographics
NPI:1487943890
Name:UKACHUKWU, PERRY OGBUGO (RPH)
Entity type:Individual
Prefix:MR
First Name:PERRY
Middle Name:OGBUGO
Last Name:UKACHUKWU
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 1:119 SE JAY AVE
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-3024
Mailing Address - Country:US
Mailing Address - Phone:541-216-1577
Mailing Address - Fax:541-278-1356
Practice Address - Street 1:1900 SW COURT PL
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-1817
Practice Address - Country:US
Practice Address - Phone:541-276-1185
Practice Address - Fax:541-278-1536
Is Sole Proprietor?:No
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0012056183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist