Provider Demographics
NPI:1578832259
Name:CHIKEZIE, CHIDINMA JENNY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CHIDINMA
Middle Name:JENNY
Last Name:CHIKEZIE
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 1:20111 WADLEY AVE
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-3046
Mailing Address - Country:US
Mailing Address - Phone:310-422-6586
Mailing Address - Fax:424-295-7999
Practice Address - Street 1:22005 AVALON BLVD STE D
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-7169
Practice Address - Country:US
Practice Address - Phone:310-422-6586
Practice Address - Fax:310-422-6586
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-23
Last Update Date:2017-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61812183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist