Provider Demographics
NPI:1346554292
Name:EZEH, CHARLES CHIKWADO
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:CHIKWADO
Last Name:EZEH
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 1:71 WOODBRIDGE TER APT K
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07095-4243
Mailing Address - Country:US
Mailing Address - Phone:646-238-0997
Mailing Address - Fax:
Practice Address - Street 1:1084 BROAD ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-2320
Practice Address - Country:US
Practice Address - Phone:973-733-2866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18625183500000X
NJ28R103335200183500000X
MI5302037725183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist