Provider Demographics
NPI:1326719600
Name:EJERE, CHINONYE JR
Entity Type:Individual
Prefix:
First Name:CHINONYE
Middle Name:
Last Name:EJERE
Suffix:JR
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 1:395 VIRGINIA WATER DR
Mailing Address - Street 2:
Mailing Address - City:ROLESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27571-9215
Mailing Address - Country:US
Mailing Address - Phone:919-995-1852
Mailing Address - Fax:
Practice Address - Street 1:395 VIRGINIA WATER DR
Practice Address - Street 2:
Practice Address - City:ROLESVILLE
Practice Address - State:NC
Practice Address - Zip Code:27571-9215
Practice Address - Country:US
Practice Address - Phone:919-995-1852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-25
Last Update Date:2021-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30718183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist