Provider Demographics
NPI:1073100855
Name:ESELE, CHIDERA C (PHARMD)
Entity Type:Individual
Prefix:
First Name:CHIDERA
Middle Name:C
Last Name:ESELE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12231 RIVER VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-1225
Mailing Address - Country:US
Mailing Address - Phone:952-465-9397
Mailing Address - Fax:
Practice Address - Street 1:12751 NICOLLET AVE
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-2806
Practice Address - Country:US
Practice Address - Phone:952-736-8130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN122971183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist