Provider Demographics
NPI:1073210696
Name:OMOREGIE, CHRIS CHUKWUDI
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:CHUKWUDI
Last Name:OMOREGIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11189 COVENTRY LN
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-3644
Mailing Address - Country:US
Mailing Address - Phone:214-226-5200
Mailing Address - Fax:
Practice Address - Street 1:11189 COVENTRY LN
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-3644
Practice Address - Country:US
Practice Address - Phone:214-226-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71659183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist