Provider Demographics
NPI:1558332528
Name:CHUKWUEKE, AMBROSE IJEOMA (BPHARM, BL, RPH)
Entity Type:Individual
Prefix:MR
First Name:AMBROSE
Middle Name:IJEOMA
Last Name:CHUKWUEKE
Suffix:
Gender:M
Credentials:BPHARM, BL, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10612 CHAMBERS DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-2621
Mailing Address - Country:US
Mailing Address - Phone:813-818-0744
Mailing Address - Fax:813-855-5540
Practice Address - Street 1:11621 RENAISSANCE VIEW CT
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-2683
Practice Address - Country:US
Practice Address - Phone:813-818-0744
Practice Address - Fax:813-855-5540
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS40769183500000X
MD28860183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist