Provider Demographics
NPI:1497138275
Name:NJIKE TAH, KELA DELPHINE
Entity Type:Individual
Prefix:DR
First Name:KELA
Middle Name:DELPHINE
Last Name:NJIKE TAH
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:DELPHINE
Other - Middle Name:KELA
Other - Last Name:NJIKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:611 BEAUHAVEN LN
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-7451
Mailing Address - Country:US
Mailing Address - Phone:617-877-1429
Mailing Address - Fax:
Practice Address - Street 1:3716 MORGANTON RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-4963
Practice Address - Country:US
Practice Address - Phone:910-868-5103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-30
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21534183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist