Provider Demographics
NPI:1376069591
Name:DIMONYE, CHUKWUKA S (PHARMD)
Entity Type:Individual
Prefix:
First Name:CHUKWUKA
Middle Name:S
Last Name:DIMONYE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23173 MEADOW WOOD CT APT 820
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19973-7763
Mailing Address - Country:US
Mailing Address - Phone:443-854-6980
Mailing Address - Fax:
Practice Address - Street 1:11085 CATHELL RD
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-9301
Practice Address - Country:US
Practice Address - Phone:410-208-3811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-18
Last Update Date:2017-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD000000000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist