Provider Demographics
NPI:1225638430
Name:CHE, TITUS ASONGWE
Entity Type:Individual
Prefix:
First Name:TITUS
Middle Name:ASONGWE
Last Name:CHE
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 1:5730 W AMARILLO BLVD
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-4004
Mailing Address - Country:US
Mailing Address - Phone:806-354-9591
Mailing Address - Fax:806-354-9668
Practice Address - Street 1:5730 W AMARILLO BLVD
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-4004
Practice Address - Country:US
Practice Address - Phone:806-354-9591
Practice Address - Fax:806-354-9668
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51105183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1922025089OtherWALMART