Provider Demographics
NPI:1346407475
Name:UFODIKE, CHIDEBELU ENYINNAYA (PHARMD, DPH)
Entity Type:Individual
Prefix:DR
First Name:CHIDEBELU
Middle Name:ENYINNAYA
Last Name:UFODIKE
Suffix:
Gender:M
Credentials:PHARMD, DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 KENNESAW DUE WEST RD NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-4338
Mailing Address - Country:US
Mailing Address - Phone:770-423-9525
Mailing Address - Fax:770-423-1019
Practice Address - Street 1:1550 KENNESAW DUE WEST RD NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-4338
Practice Address - Country:US
Practice Address - Phone:770-423-9525
Practice Address - Fax:770-423-1019
Is Sole Proprietor?:No
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH022928183500000X
MD17848183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist