Provider Demographics
NPI:1326174442
Name:NKENGLA, CHO
Entity Type:Individual
Prefix:DR
First Name:CHO
Middle Name:
Last Name:NKENGLA
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 1:8787 SOUTHSIDE BLVD APT 3710
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-3602
Mailing Address - Country:US
Mailing Address - Phone:630-664-5969
Mailing Address - Fax:
Practice Address - Street 1:5207 NORMANDY BLVD
Practice Address - Street 2:WINN-DIXIE PHARMACY
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205-4827
Practice Address - Country:US
Practice Address - Phone:904-786-4639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS39850183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist