Provider Demographics
NPI:1558900290
Name:ANYIGBO, JIDERECHUKWU UGONNA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JIDERECHUKWU
Middle Name:UGONNA
Last Name:ANYIGBO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:JIDE
Other - Middle Name:U
Other - Last Name:ANYIGBO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:780 FIRESTONE AVE UNIT 70152
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38107-1537
Mailing Address - Country:US
Mailing Address - Phone:832-444-9465
Mailing Address - Fax:
Practice Address - Street 1:232 KEEL AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38107-3736
Practice Address - Country:US
Practice Address - Phone:832-444-9465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-28
Last Update Date:2019-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN40599183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist