Provider Demographics
NPI:1609253061
Name:EZENWOYE, CHISOM (PHARM D)
Entity Type:Individual
Prefix:
First Name:CHISOM
Middle Name:
Last Name:EZENWOYE
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6503 43RD AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-3301
Mailing Address - Country:US
Mailing Address - Phone:206-883-6501
Mailing Address - Fax:
Practice Address - Street 1:16735 SE 272ND ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:WA
Practice Address - Zip Code:98042-4942
Practice Address - Country:US
Practice Address - Phone:206-883-6501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-05
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60475633183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist