Provider Demographics
NPI:1225763246
Name:EJIM, CHINYERE
Entity Type:Individual
Prefix:
First Name:CHINYERE
Middle Name:
Last Name:EJIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3423 ORCHARD BRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77471-1766
Mailing Address - Country:US
Mailing Address - Phone:508-345-2729
Mailing Address - Fax:
Practice Address - Street 1:307 S FRIENDSWOOD DR
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-3954
Practice Address - Country:US
Practice Address - Phone:346-313-8575
Practice Address - Fax:346-313-8576
Is Sole Proprietor?:No
Enumeration Date:2022-07-22
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX49524183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist