Provider Demographics
NPI:1497535652
Name:UKEGBU, KELECHI NDIRIBE CAMILLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:KELECHI
Middle Name:NDIRIBE CAMILLE
Last Name:UKEGBU
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 MULLEN CT
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:GA
Mailing Address - Zip Code:30248-2500
Mailing Address - Country:US
Mailing Address - Phone:615-491-6022
Mailing Address - Fax:
Practice Address - Street 1:1271 GRAY HWY
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31211-1919
Practice Address - Country:US
Practice Address - Phone:478-743-6979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH031996183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist