Provider Demographics
NPI:1376268672
Name:IFEDILI, CHIJIOKE JOHN (RPH)
Entity Type:Individual
Prefix:
First Name:CHIJIOKE
Middle Name:JOHN
Last Name:IFEDILI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 DIAMOND RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-7126
Mailing Address - Country:US
Mailing Address - Phone:404-324-7866
Mailing Address - Fax:
Practice Address - Street 1:1550 N SANDHILLS BLVD
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:NC
Practice Address - Zip Code:28315-2304
Practice Address - Country:US
Practice Address - Phone:910-944-0438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC31677183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty