Provider Demographics
NPI:1215554894
Name:CHIME-UDEH, ELIZABETH EJIMNKEONYE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:EJIMNKEONYE
Last Name:CHIME-UDEH
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 1:48 ARLEN WAY
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06117-1106
Mailing Address - Country:US
Mailing Address - Phone:860-798-9244
Mailing Address - Fax:860-232-1852
Practice Address - Street 1:48 ARLEN WAY
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06117-1106
Practice Address - Country:US
Practice Address - Phone:860-798-9244
Practice Address - Fax:860-232-1852
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-30
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.00072921835P0018X, 1835P1200X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy