Provider Demographics
NPI:1033491253
Name:IHEDIGBI, CHIMA E (PHARMD)
Entity Type:Individual
Prefix:
First Name:CHIMA
Middle Name:E
Last Name:IHEDIGBI
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 1:1905 CAROLINE ST APT E
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:39819-4271
Mailing Address - Country:US
Mailing Address - Phone:229-246-1441
Mailing Address - Fax:
Practice Address - Street 1:1905 CAROLINE ST APT E
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:39819-4271
Practice Address - Country:US
Practice Address - Phone:229-246-1441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH025331183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARPH025331OtherGEORGIA BOARD OF PHARMACY